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Payment for Routine Office Visits Varies Substantially

WEDNESDAY, Sept. 18 (HealthDay News) -- There is substantial variation in private insurance payment to physicians for routine office visits, according to research published in the September issue of Health Affairs.

Laurence Baker, PhD, from Stanford University in California, and colleagues retrospectively analyzed 40 million insurance claims for routine office visits, consultations, and preventive visits in 2007, to determine variations in private payments to physicians and the extent to which these variations are explained by patients' and physicians' characteristics and by geographic region.

The researchers found much variation in payments for routine evaluation and management services, with physicians at the high end of the payment distribution being paid more than twice what physicians at the low end were paid for the same service. Patients' age or sex, physicians' specialty, place of service, whether the physician was a "network provider," or type of plan explained little variation. Approximately one-third of the variation was associated with the geographic area of the practice.

"Interventions that promote more price-consciousness on the part of patients could help reduce health care spending, but more data on the specific causes of price variation are needed to determine appropriate policy responses," the authors write.

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