Report: High-priced doctors are making even more money

DATE: May 31, 2019

The Center for Health Information and Analysis says the percentage of commercial payments made to the most expensive doctor’s groups is growing.

The most expensive doctors in Massachusetts are receiving more money than in the past, a recent state report has found, an indication that efforts to divert patients to less expensive providers aren’t making meaningful progress.

According to an analysis from the Center for Health Information and Analysis, the percentage of commercial payments made to the most expensive doctor’s groups in the state has been growing steadily for several years. Approximately $3.5 billion went to the highest-priced quartile of doctors in 2016 — or 68.4 percent of the $5.1 billion paid to physician groups that year.

That’s an increase from 2015, when $3.3 billion went to the highest-priced quartile of doctors — or 59.9 percent of the $5.51 billion spent on physician groups that year.

The amount of money going to the state's most expensive doctors has been rising since 2013, state data shows, despite concerted efforts to establish insurance products to divert patients to more affordable sites of care.

Analysts were unsure whether the increases were because physicians were seeing more patients, or if the prices of the services they offered were increasing.

“The aggregate nature of the data only allows us to infer that more payments have gone to physician groups in the highest-price quartile,” said Emma Schlitzer, a spokesperson for the Center for Health Information and Analysis, which released the data on Thursday.

In the commercial market, the most expensive providers in the state include:

The Fertility Center of New England
Boston IVF
The Children’s Hospital Corporation
Massachusetts Eye and Ear
Anesthesia Associates of Massachusetts

While the state hasn’t made much progress in reducing commercial payments to expensive physicians, Massachusetts is seeing reductions in commercial payments to expensive hospitals.

According to data looking at payments for inpatient and outpatient services to patients, $4.59 billion went to the highest-priced quartile of hospitals in 2017 — or 48 percent of the $9.57 billion spent on hospitals statewide.

That’s down from 2016, when $4.82 billion went to the highest-priced quartile of hospitals — or 51.1 percent of the $9.45 billion spent on hospitals statewide.

The amount of money sent to the state’s most expensive hospitals has been declining since 2014.

Despite the progress, community hospitals are still paid less than their academic medical center peers. The data showed that the average academic medical center was 18 percent more expensive than the average hospital in the state. Meanwhile, the average community hospital was 6 percent less expensive than the average hospital in the state.

In the commercial market, the most expensive hospitals in the state include:

Nantucket Cottage Hospital (Partners HealthCare)
Martha’s Vineyard Hospital (Partners HealthCare)
Boston Children’s Hospital (Independent)
Massachusetts General Hospital (Partners HealthCare)
Falmouth Hospital (Cape Cod Healthcare)

The findings are bound to provide fodder for community hospitals, which have been fighting since last year to receive reimbursements comparable to other hospitals. Legislative leaders have promised to take another look at the issue this legislative session.

- Jessica Bartlett – Reporter, Boston Business Journal