The off-label marketing for antipsychotic drugs allegedly occurred while AstraZeneca was already under a 2010 federal corporate integrity agreement for Medicaid fraud.
AstraZeneca will pay the Texas $110 million to settle allegations that the drug maker illegally marketed two antipsychotic drugs to Medicaid providers in the state, Attorney General Ken Paxton announced.
According to Texas prosecutors, AstraZeneca ran the misleading marketing schemes at a time when the company was already under a 2010 federal corporate integrity agreement resulting from prior allegations of Medicaid fraud.
The federal agreement banned AstraZeneca from promoting its antipsychotic medication Seroquel and cholesterol-lowering statin drug Crestor for uses not approved by the Food & Drug Administration, but Texas alleged the company continued to do so anyway.
Paxton said the drugs were promoted primarily to treat children and adolescents and that AstraZeneca made hundreds of thousands of dollars in illegal payments to two former state hospital doctors to unduly influence the use of Seroquel in the state hospital system.
"The allegations that led to this settlement are especially disturbing because the well-being of children and the integrity of the state hospital system were jeopardized," Paxton said.
Paxton noted that AstraZeneca was accused of a similar nationwide marketing fraud scheme involving Crestor, that included a "plan of deception" targeting Texas Medicaid to expand statin use beyond what the science supported, while downplaying the risk of diabetes in some patients.
AstraZeneca Responds
AstraZeneca issued a statement Wednesday morning confirming the settlement, but adding that it "makes no concessions or admissions of fault."
"While AstraZeneca denies the allegations, it is in the best interests of the company to resolve these matters and to move forward with our business of discovering and developing important, life-changing medicines – while avoiding the delay, uncertainty, and expense of protracted litigation," the drug maker said.
The plan does not expand negotiating powers directly to the federal government and Part D drugs, which prompted one critic to call the policy shift 'small potatoes.'
The Centers for Medicare & Medicaid Services is rescinding an Obama-era policy that prohibits Medicare Advantage plans from negotiating lower Part B drug prices for their enrollees.
Under the revised policy announced Tuesday, enrollees starting in 2019 can choose Medicare Advantage plans that mandate the use of preauthorized but less-expensive drug formularies, with at least half of the savings generated by the "step therapy" passed back to enrollees, CMS said.
Medicare Advantage plans have been denied the negotiating tools for Part B drugs that commercial plans commonly use when negotiating lower drug prices, CMS Administrator Seema Verma told reporters Tuesday.
"What we are essentially allowing them to do is to introduce step therapy for Medicare Part B drugs," she said. "The plans have the option of using that tool. That might help them negotiate better discounts. It might encourage manufacturers to lower their prices. It will also encourage them to direct patients to high-value medications."
Medicare Advantage plans will have the ability to "cross-manage" drugs covered under different parts of Medicare, allowing them to pay for the most appropriate, most affordable drugs, regardless of whether patients receive them in a doctor’s office (Part B) or at a pharmacy (Part D), Verma said.
CMS estimates that the policy shift could generate between 15% and 20% savings within the $11.9 billion spent annually on prescription drugs in Medicare Advantage.
Verma was asked at the briefing why CMS limited the negotiating ability to Medicare Advantage, and did not expand those powers to include the federal government, which is the world's largest purchaser of prescription drugs.
"This will impact about 20 million Americans, about 33% of our Medicare enrollees," Verma replied. "This is just one of the many things we are doing with the president's blueprint. We will be continuing to make announcements over the coming weeks so that we can make sure we are getting the best deals for Americans on drug pricing."
The plan received mixed reviews from stakeholders.
"PhRMA has serious concerns with the new CMS guidance regarding Medicare Advantage coverage of Part B medicines and the implications for patients suffering from complex conditions," PhRMA said in a media release.
"Step therapy will delay many patients' access to medicines they need, interfere with the patient-physician relationship and increase burdens on physicians to comply with new, more complicated requirements. The bottom line is this guidance prioritizes the interests of middlemen while increasing out-of-pocket costs for some patients," PhRMA said.
However, the Pharmaceutical Care Management Association praised the new policy as "an important step toward reducing costs for the program and beneficiaries."
"Some of the highest priced drugs are found in Medicare Part B, where PBMs currently don't play any meaningful role," PCMA said.
The reaction was also mixed among consumer groups.
Peter Maybarduk, director of Public Citizen's Access to Medicines Program, called the policy "small potatoes" when compared to what the federal government could do to make drugs more affordable.
"Adjusting the rules for Medicare Advantage plans under the much smaller Part B program is a much smaller change than giving the government power to negotiate directly for Part D," Maybarduk said.
Instead, Maybarduk accused the Trump administration of "protecting Big Pharma."
"Even if Medicare Advantage plans for Part B somehow reduced their costs from $12 billion to zero, that still would produce less in savings than the government simply negotiating prices directly for the $100 billion Part D program," Maybarduk said.
However, David Mitchell, president and founder of Patients For Affordable Drugs, called the new policy "a small but positive step" that gives Medicare Advantage plans "greater leverage to negotiate with drug corporations."
Mitchell said that concerns about the potential misuse of step therapy are legitimate, "but as long as patients are protected with a timely and workable appeals process, allowing step therapy in Medicare Advantage is a step I can support."
First-of-its-kind initiative bypasses insurance middlemen and hopes to lower costs by improving access to primary care and pushing preventive medicine, wellness initiatives.
Henry Ford Health System and General Motors have signed what they're calling a first-of-its-kind "Direct to Employer" contract to provide care for the automaker's 24,000 employees and their families in Southeast Michigan.
GM employees who select the automaker's "ConnectedCare" plan can access Henry Ford healthcare services including primary care, more than 40 specialties, behavioral health services, hospitalization and emergency care, pharmacy and other services, according to a joint media release.
"GM's upcoming ConnectedCare option comes from our ongoing quest to improve employee health, while also seeking to offset rising healthcare costs for both the employee and the company," Sheila Savageau, US Healthcare Leader, General Motors, said in prepared remarks.
"Partnering with a regional healthcare leader like Henry Ford Health System enables us to provide an innovative new plan option for high quality, affordable care," she said.
Under the contract:
ConnectedCare will provide access to more than 3,000 providers from a network of primary care and specialty care doctors in communities where GM employees live. Open enrollment begins this fall, with service beginning in 2019.
Henry Ford will help GM enrollees track of their health with regular wellness exams, monitoring chronic conditions, and preventive screenings.
The health system will push members to less-expensive care venues, such as walk-in clinics rather than emergency rooms for minor illness and injury.
GM enrollees will have dedicated resources for appointment scheduling and other services and access to same-day or next-day appointments with a primary care physician and the ability to see a specialist within 10 business days."
"If you talk to a lot of brokers and consultants around the country, they've been pushing for this idea of direct contracting as a way to save money and narrow not only the healthcare spend, but their exposure to various levels of quality and cost variation,” Bret Jackson, president of The Economic Alliance for Michigan, told EBN.
"This is a move that we knew was coming. But [GM's move] to contract where their headquarters are, and being in a market where there is a lot of hospital competition, sends a strong signal of what the future means for employee benefits," Jackson said.
The hospital lobby has responded to CMS Administrator Seema Verma's invitation to review the Stark Law and adapt it to value-based care.
The American Hospital Association has made a patient-centered plea for Stark Law reforms.
In a 23-page letter to Centers for Medicare & Medicaid Services Administrator Seema Verma, AHA General Counsel Melinda Reid Hatton offered a detailed proposal that would allow hospitals and physicians to provide coordinated, value-based care and not run afoul of the Stark Law.
"To reach the full potential of a value-based health system, the Stark compensation regulations must be reframed to meet the objectives of the new system, through the creation of a new exception designed specifically for value-based payment methodologies," Hatton's letter said.
To demonstrate how each of the AHA's proposed amendments would directly benefit patients, Hatton used "Wayne," a hypothetical 75-year-old man with multiple chronic illnesses and a limited home care network.
AHA called on CMS to do the following:
Amend undue constraints on how hospitals finance infrastructure improvements, such as multi-site electronic health records. "For Wayne, shared electronic systems across his care team would mean no longer answering the same questions or completing duplicate paperwork every time he has an appointment or contact with someone on his care team."
Remove barriers to incentive programs that reward physicians who "adhere to defined care pathways." AHA says that current protections for incentive arrangements are "haphazard combinations of exceptions… anchored in 'hours worked' or 'resources expended'" and designed for independent physicians, not collaborators. "For Wayne, care pathways would mean having the most current treatment options available to meet his particular needs."
Enhance incentives for efficient treatment options, and provide specific exemptions that protect cost-saving arrangements. This could include sharing the bottom-line cost savings with collaborating physicians. For example, hospitals and physicians could establish specific cost-savings actions such a using standardized devices or drug formularies. "For Wayne, a formulary would mean he is prescribed a drug that is best suited to his needs and the most cost-effective for him."
Remove barriers that discourage team-based care, and allow for financial rewards to physicians for care coordination, which otherwise could run afoul of the volume/value prohibition that links payment to the volume of potential referrals for hospital services. "For Wayne, having a care team means he can make a call to multiple team members to discuss his concerns and avoid an unnecessary trip to the emergency department or prevent a cascade of difficulties that would land him back in the hospital."
"We believe that value-based arrangements protected by the new exception will not carry the risk of overutilization addressed by the Stark Law," Hatton wrote. "Our proposed exception draws on safeguards included in the Waivers for the MSSP, as well as certain other requirements intended to protect the Medicare and Medicaid programs against abuse in the fee-for-service context."
The physician gender pay gap is real, it's persistent, and it occurs across all medical specialties. The causes are complex, which makes finding solutions difficult.
A recent survey showing that male physicians in Maryland earn about 50% more in annual compensation than their female peers came as no surprise to Theresa Rohr-Kirchgraber, MD.
"Women physicians earn less than male physicians in almost every specialty and this is not new," says Rohr-Kirchgraber, executive director of the Indiana University National Center of Excellence in Women's Health, and a professor of clinical care and pediatrics.
She has been studying and speaking on gender pay inequities for years, and says that while the phenomenon is real, it defies an easy explanation.
In an email exchange with HealthLeaders, Rohr-Kirchgraber offered five reasons why the gap exists:
"Women physicians feel an additional burden when seeing patients and typically will feel as if we can never quite do enough," she says. "Therefore we may not bill at the level we should. We worry about the effect of the bill on the patient and then bill at lower levels."
"Even if the initial salary is the same as men, we are, in general, poor negotiators and may not negotiate up front for things that would improve our practice capability," she says. "For example, we had two researchers who came in on the same salary, one negotiated for larger research lab space and research techs, while the other did not. Guess who was further along in their career after 10 years?"
"The practice of medicine is not just about salary but about support. For example, if I only have one medical office assistant working with me, my patients wait longer and my turnaround times are longer," she says. "Most of our male physicians have a 'chaperone' in the room with them who can then help to speed things up especially with paps and pelvics."
"Women and underrepresented minorities score lower on patient satisfaction scores. For many of us, the patient satisfaction scores are a component of our reimbursement for salary," she says. "So, just being a woman, my scores will be lower, and I will make less at the end of the year. The assumption is not that we are worse physicians, but that the expectation is higher for us."
"We don't negotiate for higher salaries when it is time to re up," she says. "We think too much about what we did not do, or how we have come up short in our own expectations, and don't realize that each time our contract comes up for renewal we should discuss an increase in our salary and a consideration for other aspects of our income."
"For example, we just started an 'Affinity group' at Indiana University Health, which is supposed to improve our physician engagement. Women like community and we are encouraged to join. But we currently have no remuneration for such activities. If we join, it takes away from our clinical practice."
The takeaway, Rohr-Kirchgraber says, is that women physicians need to bill and code in a way that better reflects the services they provide, must demand more more transparency in the workplace around salaries, and push to remove patient satisfaction scores as a factor in salary determinations.
Beaumont says it has cooperated with prosecutors to uncover undue compensation to referring physicians allegedly made before the health system was formed in 2014.
Detroit-based William Beaumont Hospital will pay $84.5 million to resolve kickback allegations levelled by four former employees in whistleblower lawsuits, the Department of Justice said.
Prosecutors alleged that, between 2004 and 2012, Beaumont hospitals in Royal Oak, Troy, and Grosse Pointe compensated eight physicians with free or substantially discounted office space and employees in exchange for patient referrals, violating the Anti-Kickback Statute and Stark Law.
The health system then allegedly submitted claims for services provided to these illegally referred patients to Medicare, Medicaid and other federally funded healthcare programs in violation of the False Claims Act.
The settlement also resolves claims that Beaumont misrepresented a CT radiology center as a qualified outpatient department in claims to federal healthcare programs.
As a result of this settlement, Beaumont will pay $82.74 million to the federal government and $1.76 million to the state of Michigan. Awards for the four whistleblowers have not yet been determined, DOJ said.
Beaumont has also entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General.
"This result should impress on the medical community the fact that we will aggressively take action to recover monies wrongfully billed to Medicare, through the remedies provided in the federal False Claims Act," US Attorney Matthew Schneider for the Eastern District of Michigan said in a media release.
"I would like to commend the new leadership at Beaumont Hospital for making things right once its past wrongdoing was brought to its attention by federal investigators," Schneider said.
Beaumont issued a statement on its website noting that the allegations arose before the eight-hospital Beaumont Health was formed in 2014, "which created a new health system with new leadership and a new mission, vision and values."
"The resolution of these matters, some of which go back to contracts originating 14 years ago, reflects Beaumont Health's commitment to the future of health care in Southeastern Michigan," Beaumont President and CEO John Fox said.
"Since the formation of Beaumont Health in 2014, the new management team has implemented additional compliance and legal review processes to ensure our effective compliance with the complex regulations applicable to health systems and to provide additional assurance that these types of issues do not arise again," Fox said.
Chicago, Baltimore, Cincinnati, and Columbus claim the Trump administration's 'death-by-one-thousand-cuts campaign' is designed to weaken the ACA and 'deceptively shift blame' to the law itself.
Four cities filed a federal lawsuit Thursday against the Trump administration, claiming the president is intentionally undermining the Affordable Care Act and violating a Constitutional duty to "faithfully execute" existing law.
"Having failed to persuade Congress to repeal the Affordable Care Act, President Trump and his Administration are waging a relentless campaign to sabotage and, ultimately, to nullify the law," read the complaint, filed this week in U.S. District Court in Maryland by the cities of Baltimore, Chicago, Cincinnati, and Columbus, Ohio.
"To that end, President Trump and his Administration are deliberately trying to make the Act fail," the complaint continues.
"They are discouraging Americans from enrolling in comprehensive plans that protect them against debilitating medical expenses. They are working to raise prices and reduce choices for Americans seeking insurance in the Act's exchanges. And they are misappropriating funds Congress allocated to support the Act, instead using those funds to attack it."
Ultimately, the complaint read, the Trump administration hopes to "deceptively shift the blame from their own actions to the Act itself" and to pressure Congress to repeal the ACA or to achieve a de facto repeal through executive action.
"There's a clear case of premeditated destruction of the Affordable Care Act," Zach Klein, Columbus city attorney, told NBC News.
Health and Human Services Secretary Alex Azar, and Centers for Medicare & Medicaid Services Administrator Seema Verma are also named as codefendants with the president in the 130-page suit. The Executive Branch watchdog group Democracy Forward has joined the plaintiffs.
The cities offer a litany of complaints about the Administration's tactics to limit the ACA's effectiveness by making it more difficult to obtain coverage through exchanges, specifically:
Misusing federal funds for advertising campaigns that instead are "smearing the ACA," and "spinning false narratives" about the success of the act;
Shortening enrollment periods; and
Imposing documentation requirements the plaintiffs deem unnecessary and onerous.
The complaint further alleges that the administration has shirked oversight of insurance rate increases and reduced rebates to consumers, in an effort to raise premiums, create uncertainty, and cause insurers to flee the markets.
The cities said their case is easy to prove because Trump and his administration "have been remarkably transparent about their intent and approach."
"'If we don't get it done' in Congress, President Trump has said, 'we are going to watch Obamacare go down the tubes, and we'll blame the Democrats . . . and at some point, they are going to come and say, 'You've got to help us,'" the complaint alleges, adding that Trump has repeatedly stated that Obamacare is "essentially dead."
The suit alleges that the Trump Administrations actions are "an affront to the rule of law."
"The Administration's actions raise questions that go to the heart of our structure of government: whether the executive branch must 'take care that the laws be faithfully executed,' U.S. Const. art. II, § 3, and whether the Constitution therefore prohibits the President and his appointees from wielding executive power to destroy a duly-enacted law," the complaint states.
A physician failed to include in the medical records a warning that the plaintiff had been diagnosed with a potentially deadly brain aneurism.
A Massachusetts Appeals Court this week upheld a $32.5 million malpractice award for a woman left paralyzed after her primary care physician neglected to include a diagnosis of a brain aneurism in her personal medical file. The health system said it will not challenge the ruling any further.
The plaintiff, Andrea Larkin, a former elementary school teacher and fitness instructor, suffered a brain hemorrhage in 2008, about 12 hours after giving vaginal birth to her daughter using the Valsalva maneuver.
Unbeknownst to Larkin's obstetricians, the woman had been diagnosed with a venous varix in 2004, which was found in an MRI after she had complained of headaches and dizziness.
Larkin's primary care physician, Jehan Johnston, MD, with Dedham Medical–Atrius Health, knew of the diagnosis, but failed to include it in Larkin's medical records.
As a result of the hemorrhage, Larkin is paralyzed and bedridden and is expected to remain so for the rest of her life, which her attorneys estimated at trial to be about 47 years. Larkin was awarded $32.5 million in 2015 following a two-week jury trial in a state court.
During that trial, the jury heard expert medical testimony that the vaginal birth had triggered the brain hemorrhage, which could have been avoided with a Caesarian section.
Marci Sindell, senior vice president for external affairs at Atrius Health, said the health system has no plans to appeal the ruling
"First and foremost, we continue to extend our heartfelt sympathies to Andrea Larkin and her family," Sindell said in an email to HealthLeaders Media.
"We are disappointed with the judge's decision, which does not reflect our physicians' dedication to the well-being of their patients and our organization's commitment to outstanding care," Sindell said.
The three-judge Appeals Court unanimously rejected Dedham Medical's demands for a new trial, which included an argument that the trial court failed to consider the health system's "charitable status" as a not-for-profit provider protected by a $20,000 liability cap under Massachusetts law.
The panel agreed with the trial judge that Dedham Medical's charitable status claim came too late in the proceedings, and only after four years of litigation and a two-week trial.
"Such a prolonged delay, the judge found, caused 'manifest' prejudice to the plaintiffs, and made amendment … inappropriate. We agree," the Appeals Court ruled.
The appeals court also rejected Dedham Medical's claims that a neurosurgeon called as an expert witness for the plaintiffs "testified beyond the anticipated testimony" laid out in a pretrial memorandum.
The appeals court said the pretrial disclosure of the expert witness's anticipated testimony "was sufficient" to provide Dedham Medical with notice that the testimony would detail "the nature and causes of the risk of undertaking the Valsalva maneuver in light of the venous varix in Andrea's brain."
A large-scale study shows the benefits for pediatric patients of sepsis protocols that were mandated by New York State in 2013.
More than one in 10 children hospitalized with sepsis die. When clinical protocols mandated by New York State are followed within an hour of detection, however, the odds of death fall 40%.
Study senior author Christopher W. Seymour, MD, a researcher and associate professor at UPMC, spoke with HealthLeaders Media about the study findings.
The following is an edited transcript.
HLM: Why did you do this study?
Seymour: The New York State Department of Health mandated protocols in sepsis care for all patients in New York State in 2013, but there's been no large-scale studies investigating the outcomes of particularized sepsis care for pediatric patients. We felt this would be a valuable contribution to public policy and also for sepsis care for pediatric patients.
HLM: Did you find that some hospitals are not following the protocol?
Seymour: Prior to the protocol in New York State, there were, was and are practice variations among hospitals. Once Rory’s Regulations were put into place, compliance with the bundle of care did improve over a quarter, but it takes time for a community hospital that primarily see adult patients to figure out the logistics of how to implement the blood culture, the antibiotics, the fluids bundle of a pediatric patient within 60 minutes.
I work in a children's hospital so that is all we see and do, but for some community hospitals they may see pediatric patient with sepsis every few years. there is definitely a learning curve for hospitals.
HLM: What's the biggest roadblock to more comprehensive utilization?
Seymour: Part of it is recognition. Sepsis is not like a heart attack, or myocardial infarction, where there are lab tests and an EKG that can make you feel confident that that is what you're diagnosing and seeing in front of you. Being able to promptly recognize sepsis, or a patient who is at risk of developing sepsis, is Part 1. Part 2 is making sure you have the equipment and institutional policies and expertise to be able to execute bundled care within the given timeframe.
HLM: How much does this protocol cost, per patient?
Seymour: That's a great question that I do not have the answer to.
HLM: Why is the protocol effective?
Seymour: There is a biologic and physiologic basis for all three interventions: Blood culture to help guide definitive treatments; antibiotics to treat bacterial infection; and fluid bundles to help reduce shock—and shock is a known cause of worse outcomes.
Also, once a patient is recognized as having sepsis, there may be a greater sense of urgency, or an awareness by the care team and more attention is paid to that patient or more resources are utilized for that patient. That may be additional lab tests or transfer to the ICU or expert consultation. It gets people focused and thinking about the patient in front of them.
HLM: Your study notes that randomized clinical trials to determine the effectiveness of individual components within the protocol bundle would be difficult. Why?
Seymour: For most providers it would be difficult to see a patient who either definitively has sepsis or is suspected of having sepsis and then decide that, for example, this patient is not going to get antibiotics.
It'd be near impossible to get providers to decide "I'll give this patient antibiotics, but this patient doesn't, even though I think they need it." Especially when we're talking about mortality in children. People believe in blood cultures and antibiotics and they are effective. Deciding a patient is not going to get those therapies is really not feasible.
HLM: How can we determine the effectiveness of components within the bundle?
Seymour: As more states adopt bundled care there will be opportunities to do analyses, not for randomized control trials, but more in-depth analyses to understand the separate benefits that are coming from these bundles. Is it the biological benefit? Is it better care being implemented because the bundle is there? There's need for more analysis to prove causality and not just association.
HLM: How do hospitals determine when to begin the protocol?
Seymour: In New York, each hospital designs their own protocol trigger. For some hospitals, it was the patient has two-out-of-four symptoms, and this means our protocol trigger and that is the start of the 60-minute clock. Some hospitals use abnormal lab tests, and that is when the clock starts. Other hospitals may use when the patient is transferred to the ICU.
This is something that hospitals and states would need to decide, because there is no universal consensus about when a patient has sepsis. New York allowed hospitals to determine their own protocols to promote wide adoptions of Rory's Regulations. If a test in the future comes out that helps people know when sepsis is happening, that would be a good starting point. Right now, without a universal definitive test it is up to each hospital and provider to make that determination.
HLM: What's the best use for your study's findings?
Seymour: It's encouraging that we found this association. Expert opinion has been that bundled care would help patients, so it is great to see a study of this size support that. Going forward, hospitals will need to look at their own practices and figure out how they could best provide timely care to pediatric patients with sepsis.
Figuring out what obstacles may be present in terms of getting antibiotics within one hour, establishing IV access, recognizing when a patient has sepsis, this study provides good support for hospitals to figure out best practices.
Hours worked, medical specialty, and productivity can't account for a huge gap in the average compensation between Maryland's male and female physicians.
In Maryland, male physicians earn almost 50% more than their female colleagues, according to a new survey.
The average annual compensation for male physicians in Maryland was $335,000, compared with $224,000 for female physicians, according to the survey of 508 physicians, which was commissioned by the Maryland State Medical Society.
The compensation disparity is consistent across medical specialties, and the survey suggests that the gap cannot be explained simply because male physicians work longer hours, or are more productive.
For example, the survey found that male family medicine physicians in Maryland earn an average of $243,000, compared to $164,000 for female family medicine physicians, a difference of 48%, and male internal medicine physicians working 41 hours a week or more earn more than 37% more than females working 41 hours a week or more.
"Something somewhat inscrutable is going on," says Travis Singleton, executive vice president at physician recruiters Merritt Hawkins, which conducted the survey. "I don't think time at work is the issue."
"When Merritt Hawkins recruits a doctor we virtually never see differences in starting salaries between male and female physicians. Most clients are more than happy to get a female physician, particularly in primary care or OBG, and will come to the table with a competitive offer," he says.
That changes, he said, "once the physician is off salary and on straight production, or is practicing in an independent setting, some sort of divergence is taking place between male and female doctor comp."
Merritt Hawkins' 2016 survey for The Physicians Foundation found that male physicians work about 4% more hours than female physicians—not a big difference.
The 2016 survey also showed that female physicians see 9% fewer patients on average than male physicians. "That’s a little more significant but not enough to account for the pronounced pay disparities noted in the Maryland survey," Singleton says.
Singleton says the differences in compensation "may boil down to practice characteristics."
"It may be possible that women see poorer, less well-paying patients than male physicians, that they bill and code less aggressively than male physicians, are less outspoken in asking for raises, and are less likely to be in private practice, where doctors typically earn more than in employed settings—combined with working fewer hours, seeing fewer patients and perhaps some level of discrimination," he says.
"We remain puzzled by these numbers, however, which are reflected in other physician comp surveys," Singleton says. "This shouldn’t be happening to the extent it is, particularly given the receptive market for female physicians, but the reality is female physician compensation does not stack up to what male doctors earn."
The survey also shows that:
Maryland physicians' earnings trail the national average. Of medical specialists tracked, 14 earn less in total compensation than the national starting salary in their specialties as tracked by Merritt Hawkins.
Only 41% of Maryland physicians surveyed said they participate in the Medicare Access and CHIP Reauthorization Act. More than one-quarter said they do not participate, and one-third are unsure.
78% of Maryland physicians said quality accounts for 20% of their compensation or less.
