Share this Article

Author

Rachel Grande

Categories

Physicians
Go Back to The Definitive Blog
A 9 minute read
what-is-a-high-cost-physician-specialty
November 7, 2019

What is a high-cost physician specialty? Excellent question. There isn’t just one way to define it. High-cost physician specialties can refer to those with the highest procedure costs, greatest revenue potential, or those with the highest-earning physicians. The question here is: high cost for whom?

Medscape published a list of the highest-paid specialists in their 2019 Physician Compensation Report, with almost 20,000 physicians across more than 30 specialties surveyed. According to the report, the five top-earning specialties are orthopedics, plastic surgery, otolaryngology, cardiology and dermatology—with the highest-paid physicians earning close to half a million dollars in annual salary.

Income, however, is just one factor. Definitive Healthcare currently tracks 119 different physician specialties for over 1.7 million physicians and allied health professionals. Using all-payer claims analytics, you can segment those physicians by specialty, highest average charge per procedure, and greatest number of total charges in a given claim year.

In the tables below, we’ve aggregated individual physician procedure analytics for the 2018 claim year to highlight high-cost specialties by both greatest number of total charges and average charge per procedure.

Top 10 physician specialties by total charges

Rank Specialty

Total Charges

(all physicians)

Highest Total Charge

(top physician)

Total # of Procedures

(all physicians)

1. 

Emergency Medicine

$87,474,010,515

$92,461,760

153,652,281

2. 

Internal Medicine

$50,930,924,624

$91,522,185

203,507,076

3. 

Family Practice

$32,072,609,075

$199,198,659

216,066,478

4. 

Orthopedic Surgery

$28,636,678,577

$32,020,388

50,358,641

5. 

Oncology - Hematology/Oncology

$28,043,060,769

$96,766,601

32,915,061

6. 

Cardiology - Cardiologist

$22,247,931,528

$997,929,320

49,199,302

7. 

Obstetrics/Gynecology

$22,206,729,287

$54,242,015

63,769,976

8. 

Radiology - Diagnostic Radiology

$22,147,466,229

$56,675,151

86,098,503

9. 

Anesthesiology - Anesthesiologist

$22,108,882,927

$51,306,250

20,174,869

10.  Surgery - General Surgery $19,794,179,663 $38,821,420 24,735,288

Fig 1 Data is aggregated using individual physician procedure analytics available on Definitive Healthcare’s Medical Claims database. Definitive Healthcare updates commercial claims analytics on a monthly basis, but the data in this table reflects charges in the 2018 calendar year.  

Historically, orthopedics and plastic surgery have held top positions as high-cost physician specialties in terms of both physician earnings and average cost per procedure. While this fact still holds true, the table above paints a much different picture of the top-ranking specialties when organized by total charges.

Segmenting physician specialties by total charges shows a strong correlation between total number of procedures and total charges—with Emergency Medicine, Internal Medicine, and Family Practice rating in the top three high-cost specialties in this category.

“Total charges” refers to the amount billed to an insurance provider for care delivery in a given calendar year. Though this number does not reflect the actual payment awarded to a care facility or provider for services administered, it can be reflective of relative patient volumes and average procedure costs.

While Emergency Medicine, Internal Medicine, and Family Practice reported the greatest procedure claims volume in 2018, they also reported some of the lowest average costs per procedure. All three specialties reported an average cost per procedure of $556 or lower, with Family Practice claiming an average cost of just $221 per procedure—the second lowest of all physician specialties measured. 

Top 10 physician specialties by average charge per procedure

Rank Specialty

Avg. Charge per Procedure

(all physicians)

Highest Avg. Charge per Procedure

(top physician)

Total # of Procedures

(all physicians)

1. 

Surgery - Neurosurgery

$1,554

$37,165

5,007,652

2. 

Plastic and Reconstructive Surgery

$1,526

$31,961

3,293,177

3. 

Radiology - Radiation Oncology

$1,433

$457,490

11,833,729

4. 

Anesthesiology - Anesthesiologist

$1,384

$28,733

20,174,869

5. 

Cardiology - Cardiac Surgery

$1,285

$16,109

921,948

6. 

Oncology - Medical Oncology

$1,001

$8,428

11,436,934

7. 

Surgery - Vascular Surgery

$996

$14,323

4,987,358

8. 

Gastroenterology

$953

$339,242

22,154,172

9. 

Surgery - General Surgery

$940

$33,586

24,735,288

10. 

Onocology - Hematology/Oncology

$913

$22,285

32,915,061

Fig 2 Data is aggregated using individual physician procedure analytics available on Definitive Healthcare’s Medical Claims Database. Definitive Healthcare updates commercial claims analytics on a monthly basis, but the data in this table reflects charges in the 2018 calendar year. 

Based on anticipated physician earnings, organizing by greatest average charge per procedure produces a list of high-cost physician specialties that is more closely aligned with expected outcomes. At an average cost of about $1,500 per procedure, the top three high-cost physician specialties in this category are Neurosurgery, Plastics, and Radiology.

Interestingly, the top ten high-cost specialties by average cost per procedure listed above have significantly lower procedure volumes than those high-cost physician specialties by total charges—highlighting the impact of these differentiating data points in high-cost classification.

The list changes even further if you choose to sort by highest average charge per procedure—representing the average procedure costs for those highest-charging physicians—with physicians in Neurology, Radiology and Podiatry reporting some of the highest average procedure charges in 2018.

Industry Expert Panel: The Impact of Value-Based Care Adoption in High-Cost Specialties 

Interested in learning more about high-cost physician specialties? Tune in to the third installment of our Value-Based Care Panel Series to hear three leading industry experts discuss how high-cost specialties are making the transition to value-based care and what opportunities exist within this arena. 

Tune in: Wednesday, November 13th at 2pm EST

Join Panelists:

  • David Rosman, MD, Service Chief Outpatient Imaging & Associate Director of Business Development at Massachusetts General Hospital
  • Deepak Sahu, MBA, Manager at Alira Health and Resident Expert on Value-Based Care
  • Tom Davenport, MD, Partner at Long Island Plastic Surgical Group and PC & Chief of Division of Plastic Surgery at Winthrop University Hospitals

Discussing:

  • Tangible impacts of value-based care in high-cost specialties like radiology and plastic surgery
  • Ways of defining and addressing “high-cost” and what this means for your business
  • Specific metrics for measuring value-based care performance

Reserve Your Spot


Continue Reading