Office laboratory tests. Perceptions of profitability.

Area of Science:

• Health Economics
• Clinical Practice Management
• Physician Reimbursement

Background:

• Theorized profitability of common office tests.
• Need to assess physician perception of test profitability.
• Investigate impact of insurance on perceived profitability.

Purpose of the Study:

• Determine if practicing internists perceive office test profitability.
• Examine differences in perceived profitability across various tests.
• Analyze how insurance coverage influences these perceptions.

Main Methods:

• Survey of 111 physicians in private practice.
• Collected data on estimated costs and receipts for office tests.
• Standardized receipts by insurance type (Medicare, Blue Cross/Blue Shield, Medicaid).

Main Results:

• Perceived receipts exceeded costs for Medicare and Blue Cross/Blue Shield.
• Perceived receipts were lower than costs for Medicaid patients.
• Estimated profits varied significantly by test, from $5.99 (electrocardiogram) to $1.01 (urinalysis) for an average insured patient.

Conclusions:

• Perceived financial incentives for office testing are highly variable by test and insurance coverage.
• Medicaid coverage is perceived as a disincentive for performing tests.
• Fee schedule reforms should be selective, considering both test type and insurance coverage.