Prices for physician services in Medicare Advantage versus traditional Medicare.

ABSTRACT:

Objectives

To compare the prices paid to physicians by employer-sponsored Medicare Advantage (MA) plans with those paid by traditional Medicare (TM) and to determine whether the relationship between MA and TM prices is affected by the generosity of MA benchmarks.

Study design

Descriptive analysis of medical claims data from the 2014-2015 MarketScan Medicare Claims Database.

Methods

We focus on claims for low-complexity office visits with an established patient (Current Procedural Terminology [CPT] code 99213) and electrocardiograms (CPT code 93000). For a given service, we identify the prices paid by MA plans and by TM in a metropolitan statistical area (MSA), which is our definition of a market. We then construct an MA-to-TM price ratio for each MSA and report the me

SUBMITTER: Chen JL 

PROVIDER: S-EPMC6053627 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature