• Christine A Sinsky and David C Dugdale.
• JAMA Intern Med. 2013 Oct 14; 173 (18): 1733-7.

ImportanceHealth care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health.ObjectiveTo quantify the Medicare payment gap between representative cognitive and procedural services, each requiring similar amounts of physician time.DesignObservational analytical study comparing the hourly revenue generated by a physician performing cognitive services (Current Procedural Terminology [CPT] code 99214) and billing by time with that generated by physicians performing screening colonoscopy (Healthcare Common Procedure Coding System code G0121) or cataract extraction (CPT code 66984) for Medicare beneficiaries.SettingOutpatient medical practice.ParticipantsMedical care providers of outpatient services.ExposureWork relative-value unit assigned to physician services.Main Outcome And MeasuresPayment for physician services.ResultsThe revenue for physician time spent on 2 common procedures (colonoscopy and cataract extraction) was 368% and 486%, respectively, of the revenue for a similar amount of physician time spent on cognitive care.Conclusions And RelevanceOur analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system’s emphasis on procedural care. We demonstrate that 2 common specialty procedures can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day’s work.

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