Fee restraint finally seems to be taking hold. Perhaps resigned to third-party dictates, doctors for the most part are holding the line on fee increases, according to the latest findings of our Continuing Survey.
Median fees for office visits to M.D.s and D.O.s in all fields of practice combined are virtually unchanged since last year. Non-surgeons actually lowered their fees in each of the five CPT codes for new-patient visits.
Office-visit fees are highest in the West, where they rose by 17 percent for an extensive new-patient visit, our survey shows. "Except for California, the economy in the West is healthy, and managed care has been here longer," explains Barbara Pappadakis, a consultant on claims coding with Medicode in Salt Lake City. "Payers are getting the message that it's cheaper in the long run to reimburse physicians equitably for primary-care management of patients. The third parties are starting to pay for these visits at higher rates."
Among the 37 major services and procedures we compared with last year, fee hikes averaged less than 5 percent. In fact, median fees for 11 procedures are the same as or lower than in 1993.
It makes little sense for doctors to raise fees across the board to keep up with inflation or boost their incomes, say several experts. "Managed care and capitation are driving income," says Karen Zupko, a practice management consultant in Chicago. "In a highly capitated market, a doctor's earnings aren't really determined by what he charges. The number of patients he has and how efficiently he takes care of them for the flat rate negotiated with the third party are much more important."
Unless your practice is entirely prepaid, you should maintain a standard fee list, even if you don't receive full reimbursement, says Stevan D. Olian of Practice Management Concepts in Burlingame, Calif. "Don't bill for what you know you'll get paid," he advises. "In many cases, your lower fee could be discounted even more, no matter what code you use. Life would be much simpler if each plan published its actual fee schedule. But that's not likely to happen."
While fees overall seem stable this year, there are some wide variations, depending on specialty. The largest percentage increase in our survey was posted by internists. They raised their median fee for flexible sigmoidoscopy by 20 percent, to $150, after reducing it by 8 percent between 1992 and 1993. The typical internist raised office-visit fees for new patients by 6 percent, and for established patients, by 12 percent.
General surgeons posted the largest dollar increase among the procedures we monitor, hiking their median fee for a partial gastrectomy by $248, to $2,367. General surgeons raised fees for eight procedures by an average of 5 percent.
Cardiologists raised their median office-visit fees for new patients by 8 percent, and for established patients by 3 percent. They increased one echocardiography fee (CPT 93307) by 7 percent and lowered another (93350) by 2 percent.
Gastroenterologists raised median office fees for new patients by an average of 18 percent. But their fees for two of the three procedures we track were virtually unchanged.
FPs hiked median office fees for new patients by an average of 6 percent, and for established patients by 11 percent. The typical FP's median charge for complete obstetrical care with a routine vaginal delivery rose by 8 percent.
GPs' office-visit fees are virtually unchanged from last year.
Pediatricians kept their fees stable, while orthopedic surgeons raised theirs by an average of 3 percent for eight procedures we monitor, while OBG specialists raised theirs by an average of 8 percent.
How do your fees stack up against the norms set by colleagues in your specialty, size of practice, and region? See the charts, tables, and commentaries that begin on page 115. For our survey methodology, see page …