Pediatric Revenue Up or Down?

I was reading “The 2006 Fee Schedule Survey: POWER to the PAYERS” article from Physicians Practice magazine, as many of us in this business often do, and I realized that a) I never compared their data with ours and b) I don’t think it agrees. So, Tim threw some numbers together for me. To begin, let’s look at some of the highlights from their piece. It’s a fascinating read.

Compensation for E&M visits dropped 10 percent nationally and 27 percent in the Northeast from 2005 to 2006.

I’m pretty sure I would have noticed a 27% decrease from anywhere! We ran our numbers comparing the E&M results for our NE pediatric clients in 2005 and 2006 for 99212-215. Something is definitely different.

Source 99212 99213 99214 99215
Physicians Practice 2006 $36.58 $51.92 $77.82 $95.54
PCC 2005 $43.15 $60.30 $88.41 $124.15
PCC 2006 $44.98 $63.20 $92.99 127.71
Difference PP/PCC -17.9% -16% -13.6% -29.9%
Difference PCC 2005/PCC 2006 4.2% 4.8% 5.2% 2.9%

First, not only do our pediatric clients in NE get paid a lot better for their E&Ms to start (about 18-20% better), but they actually recognized a 4+% increase in the codes from 2005 to 2006…while Physicians Practice reported a 27% decrease! Some caveats: I only looked at the 9921x codes. PP used about a dozen other codes (though none of the well visit/9939x, unfortunately) to determine their overall results. We obviously have that data, too, and it shows the same results. PP may also be getting a different sample from 2005 to 2006, though we both believe there is a lot of crossover (i.e., the same folks complete the surveys each year). Who knows, maybe their pediatric sample is bad? I’m beginning to think, though, that PCC’s sample is getting too biased. When PP says:

Physicians need to get smarter about negotiating and look for other revenue sources.

…I realize that our clients are already doing this. How else do they see their reimbursement go up 4% while it drops precipitously for everyone around them?

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