Comparison of Primary Care Physician Reimbursement Rates in the United States

Area of Science:

• Health Economics
• Physician Workforce Studies

Background:

• Growing physician shortage, especially in primary care.
• Physician pay in Hawai'i is an under-researched area.
• Anecdotal evidence suggests low reimbursement rates.

Purpose of the Study:

• To objectively assess physician reimbursement in Hawai'i.
• Compare Hawai'i's rates to national averages and similar cost-of-living areas.
• Identify potential solutions for increasing physician pay.

Main Methods:

• Utilized FAIR Health data for private insurance reimbursement rates.
• Compared CPT code 99213 reimbursement across the US.
• Analyzed Medicare and FAIR Health rates in Hawai'i versus comparable cities.

Main Results:

• Hawai'i ranks in the second lowest quintile for private insurance reimbursement nationally.
• Physicians in Hawai'i are reimbursed significantly less than in cities with similar living costs.
• Both Medicare and private insurance rates are lower in Hawai'i.

Conclusions:

• Current physician payment in Hawai'i is inadequate.
• Urgent need for revised payment methodologies to recruit and retain physicians.
• Recommendations include revising payment models, Medicare Geographic Price Cost Indices, and utilizing bonus programs for Health Professions Shortage Areas.