Doctors bill commercial insurers an average of $3.8 million per year, a figure well in excess of their pay, according to a new report from AMN Healthcare.
In an analysis of commercial health insurer claims from 2021, general surgeons billed the most — an average of $11.7 million per year — while pediatricians billed the least — an average of $1.3 million per year.
The figures don’t include public payer claims; nor do they take into account the downstream revenue generated by physicians, the report noted. And although claimed amounts don’t reflect the revenues that ultimately come in, even at an estimated 50% return, the average income generated by a doctor is $1.9 million, it stated.
“Doctors directly generate 20% of healthcare revenues, but the other 80% they have influence over as well,” Linda Murphy, president of revenue cycle solutions at AMN Healthcare, told MedPage Today. “You can’t get an ultrasound without having a physician order. You can’t get labs without having a physician order. They are the gatekeepers in patient care.”
Doctors who practice in diagnostic, surgical, and internal medicine subspecialties generated higher billing than primary care doctors, the report found. The average billing for specialists was $4.65 million, compared with $1.77 million for primary care doctors.
That’s because surgical, diagnostic, and other procedures performed by specialists are typically compensated at higher levels than the consultation services typically performed by primary care doctors, the report stated.
The top 10 specialties with the highest average annual billing to commercial payers were:
- General surgery: $11.7M
- Orthopedic surgery: $9.8M
- Critical care: $6.7M
- Urology: $5.9M
- Gastroenterology: $5.5M
- Otolaryngology: $4.2M
- Ob/gyn: $3.8M
- Rheumatology: $3.4M
- Cardiology: $3.4M
- Anesthesiology: $3.3M
Including claims submitted to Medicare and other government payers would significantly increase average billing amounts for most healthcare providers, Murphy said.
For instance, rheumatologists, oncologists, and other specialists who treat a large number of older patients could double their total claim amounts, the report stated. Including public payer claims would have a smaller impact on pediatricians and other specialists who treat fewer older patients.
AMN Healthcare is working on a separate report assessing public payer claims, Murphy said.
Advanced practice providers (APPs) also generate significant revenues, the report found. Certified registered nurse anesthetists (CRNAs) submit an average of $1.75 million in claims each year, while nurse practitioners (NPs) submit around $777,000 on average each year.
“Advanced practice professionals are playing a greater role in healthcare delivery due to state policies that have expanded their scope of practice and due to the physician shortage,” Murphy said in a statement. “Their role as revenue generators has expanded correspondingly.”
Murphy emphasized that the report is a benchmark, and not a holistic look at the revenues generated by doctors and other healthcare providers.
“We don’t want physicians’ employers to look at this and say, ‘You’re not doing enough, you need to work harder,'” Murphy said.
Often, there are other issues at play when money is left on the table, such as making sure to capture the right code for a specific visit. A previous AMN Healthcare study found that $107 billion was lost through the revenue cycle, either because it wasn’t captured, or claims were denied, or penalties were assessed, Murphy said.
“The work is being done, it’s just not being captured appropriately,” Murphy said. “The goal is not to say, ‘Hey, you need to see more patients.’ It’s to look at the way patients are treated, the way you’re capturing the information in the patient chart, and understand there’s a holistic view. Its not just asking the doctors to do more.”
Murphy acknowledged that despite efforts to move the U.S. healthcare system to one that’s more grounded in value-based care, performance-based metrics still rule the day. Physician compensation is still tied to production as measured by outcomes such as relative value units (RVUs), the number of patients seen, or claims submitted.
“Quality-based physician payments remain largely aspirational,” Tom Florence, president of AMN Healthcare’s physician solutions division, said in a statement. “We are still in a system where physicians are rewarded on volume of services they provide or revenue they generate.”
The “2023 Physician Billing Report” from AMN Healthcare assessed commercial insurance claims representing about 95% of the commercial claims submitted by doctors, NPs, and CRNAs in 2021. Claims were analyzed for 18 specialties, and in addition to averages, AMN Healthcare calculated the 25th and 75th percentiles for each specialty, noting that amounts will vary by a host of factors including geography.
The report illustrates the central role of physicians as revenue-generators in today’s healthcare system, and how they remain “key catalysts” of how dollars are spent in healthcare.
“You have to look at the full scope of physician activity in order to understand the value that they bring to healthcare, but more importantly, to the patients they care for,” Murphy said.