California Doctors Among Those Charging Medicare the Most for Office Visits

Caption will go here. (John Moore/Getty Images)

More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)

By Lisa Aliferis, April Dembosky and Lisa Pickoff-White

When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor’s time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.

Three California doctors are among the top five nationally in billing for the most complex office visits.

Most doctors’ billing patterns to the Medicare program fall in the middle ground between simple and complex.

In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine — and bill — a large proportion of their office visits as complex.

Now an analysis of Medicare billing data — which was made public for the first time last month — shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty. Continue reading

California Faces Headwinds in Easing Doctor Shortages

By David Westphal, CHCF Center for Health Reporting

The Supreme Court’s validation of President Obama’s landmark health law sets off a scramble across California to find enough primary care doctors and other professionals to serve an estimated 3 million newly insured patients by 2014.

California already rates below average in the number of doctors per capita.  But the state – rural counties in particular – will face additional headwinds as health reform slashes the ranks of its 7 million uninsured.

California has an unusually large number of doctors heading into their retirement years.  It expects a much higher-than-average rise in the health-intensive 65-and-older population.  And it has one of the lowest reimbursement rates in the country for Medi-Cal, the state’s primary program offering health coverage for the poor.

Especially for communities that are already struggling with doctor shortages, the court’s somewhat unexpected endorsement of the Affordable Care Act suddenly presents a steep challenge.

“What good is it in 2014,” when millions of uninsured Californians will gain coverage “when they don’t have access to providers?”

“The Affordable Care Act will add hundreds of thousands of people to the rolls of the insured.  That’s good,” said Dr. G. Richard Olds, founding dean of the UC Riverside School of Medicine.  “But where are the primary care physicians going to come from to serve that population?”

According to a 2009 study by the California HealthCare Foundation, only 16 of 58 California counties had sufficient primary care doctors as measured against standards set by the American Medical Association.  The Association of American Medical Colleges has warned the nation could reach a shortfall of nearly 100,000 doctors by 2020. Continue reading