The Growing Executive-Physician Wage Gap in Major US Nonprofit Hospitals and Burden of Nonclinical Workers on the US Healthcare System

Du, Jerry Y.; Rascoe, Alexander S.; Marcus, Randall E.

doi:10.1097/corr.0000000000000394

Cited by 28 publications

(24 citation statements)

References 15 publications

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“…Increased administrative burden has led to an increase in administrators in health care, who become their own costs and have yet to prove their value. 1 As the U.S. economy continues to suffer from the COVID epidemic, the fiscal solvency of Medicare becomes worrisome. Medicare Part A is funded by payroll taxes and income taxes on Social Security benefits.…”

Section: See Related Article On Page 1632mentioning

confidence: 99%

Editorial Commentary: Medicare Cost-Containment Programs Reduce Reimbursement, Complicate Care, and Increase Administrative Costs: Alarm Bells Are Ringing and Physicians Must Get Involved

Neviaser

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Medicare cost-containment efforts have uniformly led to a reduction in physician reimbursement offset by increasing administrative burdens and costs and complicating delivery of care. Surgeons who face decreasing compensation for Medicare patients may be forced to limit the number of these patients for whom they care. Decreasing physician reimbursement from Medicare typically translates into a similar reduction by private payers. Administrators who come at a cost have yet to show proven value. All of this translates into limiting our ability to care for patients. We are facing a critical moment for potential change prompted by a global health crisis, a new administration, a new legislature, and an increased appreciation for health care delivery among the American public. As physicians, we need to be active participants in changing the system, placing a greater priority on delivering optimal care at optimal cost. We should use this moment when the American public is focused on the need for health care to reprioritize Medicare funding and physician reimbursement while urging reductions of government spending on bureaucracy. This requires actively lobbying lawmakers and speaking collectively.

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Section: See Related Article On Page 1632mentioning

confidence: 99%

Editorial Commentary: Medicare Cost-Containment Programs Reduce Reimbursement, Complicate Care, and Increase Administrative Costs: Alarm Bells Are Ringing and Physicians Must Get Involved

Neviaser

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…4,8,20 However, inpatient and hospital facility costs have been shown to be significant drivers of health care expenditures for surgical procedures, 9,14,15,18,[22][23][24] and a substantial administrative burden, including wages for nonclinical workers and the costs of nonclinical tasks, has increased out of proportion to health care utilization. 10 In response, alternative payment models have been proposed to create a shared-risk partnership among providers that incentivizes cost-efficiency and care quality. 12,19,22,26 Despite efforts to curtail orthopedic surgery costs, hospital and administrative payments have continued to rise while average surgeon reimbursements have fallen.…”

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confidence: 99%

“…12,19,22,26 Despite efforts to curtail orthopedic surgery costs, hospital and administrative payments have continued to rise while average surgeon reimbursements have fallen. 2,5,7,10,17,27,29 Given the rising costs of practice overhead, declining reimbursements may be unsustainable for surgeons and may disincentivize care for higher-risk patients and participation in value-based care models. Further analysis and enhanced understanding of recent trends in the allocation of health care expenditures and reimbursements will enable surgeons and policy makers to improve current payment and delivery models.…”

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confidence: 99%

Recent trends in Medicare utilization and surgeon reimbursement for shoulder arthroplasty

Lopez

Boddapati

Anderson

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Recent efforts to contain health care costs and move toward value-based health care have intensified, with a continued focus on Medicare expenditures, especially for high-volume procedures. As total shoulder arthroplasty (TSA) volume continues to increase, especially within the Medicare population, it is important for orthopedic surgeons to understand recent trends in the allocation of health care expenditures and potential effects on reimbursements. The purpose of this study was to evaluate trends in annual Medicare utilization and provider reimbursement rates for shoulder arthroplasty procedures between 2012 and 2017. Methods: This study tracked annual Medicare claims and payments to shoulder arthroplasty surgeons via publicly available databases and aggregated data at the county level. Descriptive statistics were used to evaluate trends in procedure volume, utilization rate (per 10,000 Medicare beneficiaries), and reimbursement rate. We used adjusted multiple linear regression models to examine associations between county-specific variables (ie, urban or rural, average household income, poverty rate, percentage Medicare population, and race and ethnicity demographics) and procedure volume, utilization rate, and reimbursement rate. Results: Between 2012 and 2017, there was an 81.3% increase in primary TSA volume and 55.5% increase in primary TSA utilization. The Midwest and South had higher utilization rates than the Northeast and West (P < .001). TSA utilization rates in metropolitan areas were significantly higher than in rural areas (P < .001). Utilization rates for primary TSA procedures also had a significant negative association with poverty rate (P < .001). Regarding reimbursements, the Medicare payment per TSA case decreased from 2012 to 2017, with overall inflation-adjusted decreases of 7.1% and 11.8% for primary and revision cases, respectively. TSAs performed in metropolitan areas received significantly higher reimbursements per case than TSAs performed in rural areas ($1108.05 and $1066.40, respectively; P ¼ .002). Furthermore, reimbursements per case were on average higher in the Northeast and West than in the South and Midwest (P < .001). Conclusions: Our study confirms that although TSA volume and per capita utilization have increased dramatically since 2012, Medicare Part B reimbursements to surgeons have continued to fall even after the adoption of bundled-payment models for orthopedic procedures. Cost-containment efforts continue to focus on Medicare reimbursements to surgeons, although other expenditures such as hospital payments and operational and implant costs must also be evaluated as part of an overall transition to value-based health care.

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“…No matter that unnecessary spending in healthcare is estimated at more than $500 billion per year, making the $4.6 billion to address burnout seem a pittance in comparison [12]. No matter that healthcare executives saw their compensation increase nearly 200% between 2005 and 2015, a period during which physician pay increased roughly 10% (largely in keeping with inflation) [13]. No matter that administrative bloat in healthcare since the 1970s has been staggering.…”

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confidence: 99%

Hard hits of distress1

Dean¹,

Talbot

2020

PRM

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The Growing Executive-Physician Wage Gap in Major US Nonprofit Hospitals and Burden of Nonclinical Workers on the US Healthcare System

Abstract: IV, economic and decision analysis.

Cited by 28 publications

References 15 publications

Editorial Commentary: Medicare Cost-Containment Programs Reduce Reimbursement, Complicate Care, and Increase Administrative Costs: Alarm Bells Are Ringing and Physicians Must Get Involved

Editorial Commentary: Medicare Cost-Containment Programs Reduce Reimbursement, Complicate Care, and Increase Administrative Costs: Alarm Bells Are Ringing and Physicians Must Get Involved

Recent trends in Medicare utilization and surgeon reimbursement for shoulder arthroplasty

Hard hits of distress1

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