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Medicare, Medicare Advantage rates nearly equal — 3 study insights

A study, published in JAMA Internal Medicine, examined physician pay rates through Medicare and Medicaid Advantage plans.

USC Assistant Research Professor Erin Trish, PhD, and colleagues reviewed 144 million Medicare, Medicare Advantage and commercial claims from 2007 to 2012 across a variety of metropolitan areas.

Researchers compared reimbursement rates for 11 common procedures.

Here's what they found:

1. Medicare Advantage rates were close to traditional Medicare reimbursement rates. However, traditional Medicare plans paid physicians more than Medicare Advantage plans.

2. Mean Medicare Advantage rates ranged from 91.3 percent of traditional Medicare rates for cataract removal in ASCs up to 102.3 percent of traditional Medicare rates for complex emergency department evaluations.

3. Medicare Advantage prices, however, were lower than traditional Medicare's prices when considering laboratory services and medical equipment.

Researchers concluded, "Traditional Medicare's administratively set rates act as a strong anchor for physician reimbursement in the Medicare Advantage market, although Medicare Advantage plans succeed in negotiating lower prices for other health care services for which Traditional Medicare overpays."

Researchers recommended that reforms could be made to transition Medicare towards premium support models to "substantially affect how physicians and other clinicians are paid."

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