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Invited Commentary
Health Care Reform
July 10, 2017

Medicare Advantage Reimbursement to Physicians

Author Affiliations
  • 1School of Public Health, University of California–Berkeley
JAMA Intern Med. Published online July 10, 2017. doi:10.1001/jamainternmed.2017.2689

The most annoying aspect of the public discourse on physician payment is the tone of victimization. Physicians complain that insurers have consolidated and are underpaying them relative to the value they generate. Insurers complain that clinicians and health care institutions have consolidated and are demanding unaffordable rates. This is uninspiring. Can some new light be shed in the darkness?

It can. In their article on physician payment rates for procedures provided to patients covered by commercial insurance, private Medicare Advantage (MA) plans, and public traditional Medicare (TM) insurance, Trish et al1 report that MA payment rates track those in TM closely but fall meaningfully below those paid by commercial insurance. This might be unremarkable except that the data reflect rates paid for the same Current Procedural Terminology codes in the same local markets by the same private health plan, which sponsors coverage for both commercial and MA enrollees.

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