Medicare Payment for Hospital-Based Physician Services

T-HRD-87-13: Published: May 13, 1987. Publicly Released: May 13, 1987.

Additional Materials:

Contact:

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

GAO discussed its responses to a series of questions about the hospital-based physician specialities of radiology, anesthesiology and pathology (RAP). These questions dealt with: (1) contractual arrangements between hospitals and physicians; (2) the level of RAP physicians' incomes and the rate of their financial return on medical training; (3) Medicare's controls on the volume of these physicians' services; and (4) geographic variations in payment rates for their services. GAO found that: (1) both written and verbal arrangements appeared to grant these physicians exclusive practice rights; (2) hospitals' staffing arrangements for these physicians were officially open, but in practice, only the physicians with contracts provided services; (3) hospitals had little incentive to bargain with hospital-based physicians to restrain their charges to Medicare beneficiaries; and (4) these physicians earned higher incomes than most other physicians and had the highest financial return on their training. GAO also found that: (1) the Health Care Financing Administration (HCFA) had no special requirements for prepayment review of RAP claims beyond those normal for all physician services; (2) three of the carriers serving the four geographic areas surveyed developed their own prepayment screens for RAP services; and (3) there was considerable variation in Medicare payments for RAP services across the geographic areas surveyed, which raised concerns over equity and reasonableness of program payments.

Sep 29, 2016

Sep 28, 2016

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Looking for more? Browse all our products here