Comparison of Primary Care Physician Reimbursement Rates in the United States.

ABSTRACT

With a growing shortage of physicians, particularly primary care physicians, the issue of adequate pay in Hawai'i is increasingly important. Anecdotal reports of low pay in Hawai'i have rarely been substantiated. Data from FAIR Health, a company that tracks private insurance reimbursement rates, is compared across the United States (US) for the CPT code 99213. In addition, FAIR Health and Medicare rates are compared for cities with both similar and disparate cost of living to Hawai'i. Hawai'i is in the second lowest quintile for payment in the US for private insurances, and providers are reimbursed significantly lower than in cities with similar cost of living by both Medicare and private insurances. Methods for increasing payment to physicians in Hawai'i are essential to recruiting the necessary workforce. Revising payment methodologies that increase pay for services in areas of unmet need, revising Medicare Geographic Price Cost Indices to better balance pay in areas of need, and making use of the 10% Medicare Bonus Program for physicians working in Health Professions Shortage Areas are first steps to creating a sustainable plan for physician payment in the future.