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Comparison of Maryland and Neighboring States' Medicaid Fees

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Comparison of Maryland and Neighboring States' Medicaid Fees Comparison of Maryland’s and Neighboring States’ Medicaid Fees to Medicare Fees FY 2018 A Chart Book March 1, 2018 Prepared for the Maryland Department of Health TABLE OF CONTENTS Chapter 1. Overview of Maryland Physician Fees…..………………………………… 3 Maryland Medicaid Physician Fees Key Findings Chart Book Organization Data Source Chapter 2. Evaluation and Management Procedure Fees……………………………… 6 Chapter 3. Surgical Procedure Fee Data ……………………………………………… 8 Chapter 4. Medical Procedure Fee Data ……………………………………………… 23 List of Figures…………………………………………………………………………… 39 2 Chapter 1. Overview of Maryland Physician Fees 3 Chapter 1. Overview of Maryland Physician Fees States Medicaid Physician Fees This chart book compares the Medicaid reimbursement Virginia and Washington, DC have separate facility and rates of Maryland and its surrounding states with non-facility fees for some procedures, but they did not Maryland’s Medicare fee schedule for FY 2017. The report facility fees for some of the procedures that are surrounding states included in this study are Pennsylvania; included in this chart book. Therefore, this chart book only West Virginia; Virginia; Washington, DC; and Delaware. compares Medicaid non-facility fees of Virginia and Washington, DC with the corresponding Medicare non- Medicare physician fees include three components: facility fees for the Baltimore region. physician’s work, practice expense (e.g., costs of maintaining an office), and malpractice insurance expense. In the following charts, facility is abbreviated as FA and The practice expense component composes, on average, non-facility is abbreviated as NF. approximately 40% of the total physician fee. When physicians render services in facilities, such as hospitals and Key Findings long-term care facilities, they do not incur a practice expense. Therefore, facility fees are typically lower than In CY 2018, average Medicare fees in Maryland are non-facility fees. approximately 6% higher than Medicare fees in Delaware, 4% higher than Medicare fees in Pennsylvania, 5% higher Maryland and West Virginia have separate facility and non- than Medicare fees in Virginia, and 7% higher than Medicare facility fees. However, Delaware and Pennsylvania do not fees in West Virginia. On the other hand, average Medicare separate facility and non-facility fees; therefore, their fees fees in Maryland are approximately 5% lower than average are compared with Medicare non-facility fees. Hence, for Medicare fees in Washington, DC. Delaware and Pennsylvania, the percentages of Medicare fees reported underestimate the percentages of Medicare fees for procedures performed in facilities. 4 V Chapter 1. Overview of Maryland Physician Fees continued Chart Book Organization The data in this chart book are presented in three sections: The charts compare Maryland and neighboring states’ Physician Fees for Evaluation and Management Medicaid fees for FY 2018 as a percentage of the corresponding Baltimore region Medicare reimbursement Procedures: This section includes data on the Medicaid rates. reimbursement rate for evaluation and management procedures as a percentage of the Medicare The charts show each state’s weighted average Medicaid reimbursement rates for Maryland. fees. Maryland Medicaid’s numbers of claims and encounters were used as the weights for fees. The average Physician Fees for Surgical Procedures: This section percentages of Medicare fees reported in this table includes data on the Medicaid reimbursement rate for correspond to the appropriate Medicare non-facility and surgical procedures as a percentage of the Medicare facility fees. More specifically, Medicaid non-facility fees are reimbursement rate for Maryland. compared with Medicare non-facility fees, and Medicaid Physician Fees for Medical Procedures: This section facility fees, reported for Maryland and West Virginia, are includes data on the Medicaid reimbursement rate for compared with Medicare facility fees. medical procedures as a percentage of the Medicare reimbursement rate for Maryland. Data Sources The information in this chart book was derived from the FY 2018 Medicaid Physician Fee Schedules for Maryland and its neighboring states. The data were collected from the Medicaid physician fee schedules of Delaware, Pennsylvania, Virginia, West Virginia, and Washington, DC. 5 Chapter 2. Evaluation and Management Procedure Fees 6 Figure 1. Evaluation and Management Weighted Average (%) of Medicare Fees 100% 93% 93% 92% 90% 84% 80% 70% 68% 70% 65% For evaluation and management 60% procedures, Maryland non-facility and facility fees ranked first (tied). 50% Delaware fees ranked second; 41% Percentage Washington, DC fees ranked third; 40% Virginia non-facility fees ranked fourth; West Virginia facility fees 30% ranked fifth; West Virginia non- 20% facility fees ranked sixth; and Pennsylvania fees ranked seventh. 10% 0% MD NF MD FA DE DC VA NF WV FA WV NF PA State 7 Chapter 3. Surgical Procedure Fee Data 8 Figure 2. Integumentary and General Surgery Weighted Average (%) of Medicare Fees 100% 93% 90% 86% 80% 77% 76% 76% 70% 65% 62% For integumentary and general 60% surgery, Delaware fees ranked first, followed by Washington, DC. 50% Virginia non-facility fees ranked Percentage third, Maryland non-facility and 40% facility fees (tied) ranked fourth, 29% West Virginia facility fees ranked 30% fifth, West Virginia non-facility fees 20% ranked sixth, and Pennsylvania fees ranked seventh. 10% 0% DE DC VA NF MD NF MD FA WV FA WV NF PA State 9 Figure 3. Musculoskeletal System Weighted Average (%) of Medicare Fees 100% 94% 88% 90% 86% 81% 80% 77% 70% 65% Delaware fees for musculoskeletal 63% system procedures were the 60% highest in the region. Maryland non-facility fees ranked second; 50% Maryland facility fees ranked third; Percentage 39% Washington, DC fees ranked 40% fourth; Virginia non-facility fees 30% ranked fifth; West Virginia facility fees ranked sixth; West Virginia 20% non-facility fees ranked seventh; and Pennsylvania fees ranked 10% eighth. 0% DE MD NF MD FA DC VA NF WV FA WV NF PA State 10 Figure 4. Respiratory Weighted Average (%) of Medicare Fees 100% 90% 86% 85% 77% 80% 76% 75% 70% 67% 62% For respiratory procedures, 60% Washington, DC fees ranked first; Delaware fees ranked second; 50% Virginia non-facility fees ranked 41% Percentage 40% third; Maryland non-facility fees ranked fourth; Maryland facility 30% fees ranked fifth; West Virginia facility fees ranked sixth; West 20% Virginia non-facility fees ranked seventh; and Pennsylvania fees 10% ranked eighth. 0% DC DE VA NF MD NF MD FA WV FA WV NF PA State 11 Figure 5. Cardiovascular System Surgery Weighted Average (%) of Medicare Fees 100% 90% 86% 79% 80% 77% 73% 70% 68% For cardiovascular surgical 61% procedures, Washington, DC has 60% the highest fees. Maryland non- facility fees ranked second; Virginia 50% 45% non-facility fees ranked third; Percentage Maryland facility fees ranked 40% 35% fourth; West Virginia facility fees ranked fifth; West Virginia non- 30% facility fees ranked sixth; Delaware 20% fees ranked seventh; and Pennsylvania fees ranked eighth. 10% 0% DC MD NF VA NF MD FA WV FA WV NF DE PA State 12 Figure 6. Hemic, Lymphatic, and Mediastinum Weighted Average (%) of Medicare Fees 100% 93% 90% 85% 80% 77% 73% 73% For selected hemic, lymphatic, 70% 66% 63% and mediastinum procedures, Delaware fees were the highest 60% in the region, followed by 50% Washington, DC fees (second), Virginia non-facility fees (third), Percentage 40% 36% Maryland non-facility and facility fees (tied for fourth), West Virginia 30% facility fees (fifth), West Virginia non-facility fees (sixth), and 20% Pennsylvania fees (seventh). 10% 0% DE DC VA NF MD NF MD FA WV FA WV NF PA State 13 Figure 7. Digestive System Weighted Average (%) of Medicare Fees 120% 106% 100% 86% 78% 80% 77% 77% For selected digestive system procedures, Delaware fees 67% ranked the highest, followed by 62% Washington, DC fees (sec0nd), 60% 52% Maryland non-facility fees (third), Percentage Virginia facility fees and Maryland facility fees (tied for fourth), West 40% Virginia facility fees (fifth), West Virginia non-facility fees (sixth), and Pennsylvania fees (seventh). 20% 0% DE DC MD NF VA NF MD FA WV FA WV NF PA State 14 Figure 8. Urinary and Male Genital Weighted Average (%) of Medicare Fees 90% 83% 83% 77% 80% 75% 70% 67% 62% 60% For urinary and male genital 60% procedures, Maryland non-facility fees and Washington, DC fees 50% 43% were tied and ranked highest in the region. Virginia non-facility 40% Percentage fees ranked second; Maryland facility fees ranked third; West 30% Virginia facility fees ranked fourth; West Virginia non-facility fees 20% ranked fifth; Delaware fees ranked sixth; and Pennsylvania fees 10% ranked seventh. 0% MD NF DC VA NF MD FA WV FA WV NF DE PA State 15 Figure 9. Gynecology and Obstetrics Weighted Average (%) of Medicare Fees 120% 109% 100% 95% 94% 91% 91% 86% 84% 81% 80% Pennsylvania fees for gynecology and obstetrics procedures ranked first in the region. West Virginia facility fees ranked second; West 60% Virginia non-facility fees ranked Percentage third; Maryland non-facility and facility fees (tied) ranked fourth; 40% Delaware fees ranked fifth; Washington, DC fees ranked sixth; and Virginia non-facility fees 20% ranked seventh. 0% PA WV FA WV NF MD NF MD FA DE DC VA NF State 16 Figure 10. Endocrine System Weighted Average (%) of Medicare Fees 100% 94% 90% 84% 80% 78% 72% 72% 70% 67% 67% 62% For endocrine system procedures, 60% Delaware fees ranked the highest. Washington,
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