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Health-Care Providers Downplay Doctor-Fee Report

Posted on: Friday, 16 September 2005, 21:00 CDT

Sep. 16--A new report saying doctor fees in Madison and elsewhere in Wisconsin are among the highest in the country is misleading, local health-care providers say.

But a local employer group says the federal report, commissioned by two Wisconsin politicians, highlights the need for cost reforms.

Yet even that group says physician charges aren't the best way to evaluate medical expenses and that local residents may not be getting a bad deal.

The report, released this week by the Government Accountability Office, says physician prices in Madison are the fourth highest in the country. Wisconsin has eight of the top 10 costliest cities in the country for doctor prices, according to the report, with La Crosse first, Wausau second and Milwaukee 16th.

"The results of this study are startling," Rep. Paul Ryan, R-Wis., said in a statement. "Wisconsinites are paying a lot more for health care because consumers lack power and providers face little competition."

Ryan and Milwaukee Mayor Tom Barrett, a former congressman, requested the analysis after previous studies showed high medical costs in Milwaukee.

The GAO also looked at hospital fees and health-care spending per worker, but Madison and most other Wisconsin cities didn't have enough data to be ranked in those areas, federal officials said. "

Milwaukee and La Crosse did have enough such data, coming in fifth and 10th highest in the country for hospital fees, respectively.

The cities ranked lower in overall spending, perhaps because residents may visit doctors and hospitals less frequently than in other cities; Milwaukee was 22nd and La Crosse 31st in that category.

The report didn't specify dollar amounts for any of the fees.

While doctors in Madison may charge higher prices than in some cities, the report is misleading because it relies solely on medical claims from federal workers enrolled in national health plans, local health-care leaders say.

Madison and other Wisconsin cities have relatively few federal employees, and most local residents are insured through local health plans, which are able to negotiate lower doctor and hospital fees, they say.

"There's probably not as many federal employees in the entire state of Wisconsin as there are in the city of Chicago," said George Quinn, senior vice president of the Wisconsin Hospital Association.

Kathryne McGowan, a vice president at Physicians Plus Insurance Corp. in Madison, said about 60 percent of Madison- area residents have one of four local health plans: Physicians Plus, Unity Health Insurance, Group Health Cooperative or Dean Health Plan.

Madison's three hospital systems and several doctor groups cut better deals for people in those plans than for the few federal workers in town in national plans, McGowan said.

"Our community has intense local competition in the local health plans that have helped keep costs down in this market," she said.

Dr. Susan Turney, chief executive officer of the Wisconsin Medical Society, cited a different reason she thinks the GAO report is misguided: It may not fully account for "cost shifting" -- when doctors charge more to people with insurance to offset Wisconsin's relatively low reimbursement rates for people covered by the government health programs Medicare and Medicaid.

"We're getting only 60 to 70 cents for each dollar for that care," she said. "People with (private) insurance are paying higher rates to cover the costs."

Even if Wisconsin doctors are charging more, it may be because they are providing more services that reduce health-care costs in other areas, said Dr. Allen Kemp, chief executive officer of Dean Health System.

Electronic medical records, which can reduce drug errors, and management systems that can get patients doctor visits quickly are more widely available in Wisconsin than in other states, Kemp said. The services can inflate doctor fees but save patients money overall by making health care more efficient, he said.

Bruce Steinwald, who compiled the report for the GAO, said the fees charged to federal workers are similar to those given other patients in national health plans. The report took "cost shifting" into account, he said. And doctors in other states have also implemented costly equipment and programs.

Chris Queram, chief executive officer of The Alliance, a health-care purchasing cooperative composed of 160 companies in south-central Wisconsin, said the report brings needed attention to rising health-care costs in Madison and elsewhere. The employer group works with doctors and hospitals to improve care and reduce expenses.

"We're looking for creative and appropriate ways to control the increase in costs," he said. "This will add to the impetus for increased disclosure of information."

But Queram said the quality of health care, and whether it leads to healthier workers and increased productivity, is more important than doctor fees.

"The question we should be asking," he said, "is what are we getting for the dollar we are spending?"

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To see more of The Wisconsin State Journal, or to subscribe to the newspaper, go to http://www.wisconsinstatejournal.com.

Copyright (c) 2005, The Wisconsin State Journal

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Source: The Wisconsin State Journal

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