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Friday Sep 29, 2017

Oct. 2 represents key 2017 MIPS deadline for some physicians

If you or your practice plans to participate fully or partially in the Merit-based Incentive Payment System in 2017, and you plan to report 90 consecutive days of data for the year, then Monday, Oct. 2, is the last day you can begin.


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Posted at 01:30PM Sep 29, 2017 by Kent Moore | Comments [0]

Thursday Aug 17, 2017

Are you ready to provide FAA BasicMed exams to pilots?

As of May 1, Congress changed the rules for how the pilots of small private planes may choose to receive medical clearance to fly. Instead of undergoing the full FAA-sanctioned physician exam, certain pilots can get certified by their personal physician.


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Posted at 04:14PM Aug 17, 2017 by Barbara Hays | Comments [0]

Thursday Apr 06, 2017

Family physician compensation stayed level in 2016

The average annual compensation for family physicians remained stable last year as a majority expressed contentment with their pay and the state of medicine.

The Medscape Physician Compensation Report 2017(www.medscape.com) shows that family physicians responding to the survey received an average of $209,000 in total compensation in 2016, up almost 1 percent from the previous year but remaining second to the last among all specialties. The average compensation for all physicians included in the survey rose more than 5 percent to $294,000, with the highest average compensation achieved once again by orthopedists at $489,000. The lowest-paid specialty was pediatrics with an average of $202,000, which represented a decrease in compensation.

When broken down by state, data showed that the three top-earning states for physicians were North Dakota ($361,000 average), Alaska ($359,000), and South Dakota ($354,000). Researchers attributed this at least partly to government efforts to bring more physicians to rural and economically disadvantaged areas.

Fifty-three percent of family physicians said they felt their compensation amount was fair, about even with the 54 percent of all survey respondents who said the same. By comparison, 52 percent of family physicians believed they were fairly compensated in 2015. Emergency medicine physicians (at 68 percent) felt the most satisfaction with their compensation in the new survey, while nephrologists (at 41 percent) were the least satisfied.

Among family physicians, 77 percent said they would choose medicine as a career if they had the choice again, in line with the overall average. But family physicians were second from the last (at 67 percent) when asked if they would choose the same specialty. Internists were last at 64 percent.

Although the survey did not disclose physician employment trends as it has in past years, it did note that self-employed physicians, on average, tend to make more than their employed colleagues ($343,000 vs. $269,000). The difference varies widely between specialties, with self-employed primary care physicians earning $223,000 and employed primary care physicians earning $214,000, a 4-percent difference.

The gender pay gap continued to shrink for primary care physicians, albeit slowly. Male physicians in primary care reported earning 16 percent more than female physicians, down from 17 percent the previous year. The gap actually widened among other specialists, where male physicians made 37 percent more then female physicians, a 4 percent increase over the previous year. Researchers said this may be because of fewer female physicians participating in some high-paying specialties.

Gender-based pay disparities are smallest at 18 percent for physicians younger than 35 years old; the pay difference is 35 percent or more for older age groups.

The pool of physicians operating in a cash-only or “concierge” practice actually diminished slightly, with 9 percent of respondents saying they belonged to those types of practices. Ten percent reported operating those types of practices in 2015.


Posted at 04:28PM Apr 06, 2017 by David Twiddy | Comments [0]

Tuesday Apr 05, 2016

Compensation for family physicians rises in new survey

Family physicians saw their average overall compensation increase last year, and they felt slightly less anxious about their pay and their profession, according to a new report.

The Medscape Physician Compensation Report 2016(www.medscape.com), released April 1, reported that family physicians made an average of $207,000 in total compensation in 2015, up 6 percent from the previous year. Most specialties saw gains in annual compensation, with the highest-paid physicians being orthopedists with an average of $443,000. The lowest-paid specialty was pediatrics with an average of $204,000.

In addition to receiving higher pay, 52 percent of all physicians (and 52 percent of family physicians) said they believed their compensation was fair. By comparison, half of all physicians and 48 percent of family physicians felt they were fairly compensated in 2014. Dermatologists (66 percent) felt the most comfort with their compensation, while urologists (42 percent) were the least satisfied. Among family physicians, 73 percent said they would still choose medicine as a career if they had to do it all over again, which is up from 69 percent five years ago. The percentage of family physicians who would stick with the specialty, however, has fallen from 44 percent in 2011 to 29 percent now.

The trend of physicians choosing to work for hospitals and other large health care groups appeared to remain steady with 35 percent of men and 23 percent of women sticking with private practice, virtually the same percentages as a year ago.

Male and female compensation continued to have a disparity, but it is shrinking. Male family physicians made an average of $220,000 versus $183,000 for female family physicians, a difference of 20 percent. The difference was 28 percent in 2011. Also, survey results showed that female physicians faced a similarly sized pay gap regardless of whether they were employed or self-employed.

Despite the continued focus on “direct primary,” “concierge,” or “direct pay” care models, those types of practices remain very much in the minority. Only 10 percent of family physicians reported being in a concierge or cash-only practice, the same amounts as in 2014. The researchers said it appeared private practice physicians looking to get away from the regulatory and financial headaches of traditional practice are more likely to go into employed positions rather than go the direct-pay route.

The survey also said 39 percent of family physicians were in an accountable care organization (ACO) and 7 percent planned to join one in the coming year. By comparison, 35 percent belonged to one in 2014 and 8 percent planned to join one.


Posted at 09:00AM Apr 05, 2016 by David Twiddy | Comments [0]

Wednesday Jul 29, 2015

Does physician compensation differ in an accountable care organization?

A new study published in the Annals of Family Medicine(annfammed.org) suggests that family physicians in accountable care organizations (ACOs) may not be paid that much differently than their counterparts in non-ACO practices. The study also raises questions about the ability of ACOs to affect cost and quality if physician payment incentives are not aligned with those of the ACO.

The study in question used data from a national survey of physician practices to compare primary care physicians’ compensation among three types of practices:

•    practices not participating in a Medicare ACO and with no substantial risk for primary care costs
•    practices not participating in an ACO but with substantial risk for primary care costs
•    practices participating in an ACO regardless of their risk for primary care costs.

Researchers measured physicians’ compensation based on salary, productivity, clinical quality or patient experience, and other factors. They then used regression models to estimate physician compensation as a function of ACO participation and risk for primary care costs while controlling for other practice characteristics. Among the findings:

•    Physicians in ACOs and non-ACO practices with no substantial risk for costs were compensated similarly; on average, they received nearly one-half of their compensation from salary, slightly less from productivity, and about 5 percent from quality and other factors.

•    Physicians not in ACOs but with substantial risk for primary care costs received two-thirds of their compensation from salary, nearly one-third from productivity, and slightly more than 1 percent from quality and other factors.

•    Participation in ACOs was associated with significantly higher physician compensation for quality; however, ACO participation was not significantly associated with compensation from salary, whereas financial risk was associated with much greater compensation from salary.

The authors concluded that although practices in ACOs provide higher compensation for quality, compared with practices at large, they provide a similar mix of compensation based on productivity and salary. The authors also concluded that incentives for ACOs may not be strong enough to encourage practices to change physician compensation policies for better patient experience, improved population health, and lower per capita costs.

As the study authors themselves ask, if physicians in ACOs and physicians outside ACOs are paid similarly, will they practice differently? The corollary question would seem to be, if they don’t, will ACOs still be able to deliver the lower cost and better quality that they otherwise promise? Only time and additional research will likely tell.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 12:05PM Jul 29, 2015 by David Twiddy | Comments [0]

Tuesday Jul 28, 2015

Primary care pay rises faster than that of specialists

Compensation for primary care physicians outpaced that of specialists last year, although the median for primary care physicians remains far less.

The Medical Group Management Association (MGMA) released its annual Provider Compensation and Production Survey Report(www.mgma.com) this week, comparing information gathered from almost 70,000 physicians and other providers.

Primary care physicians received a median compensation of $241,273 in 2014, a 3.6 percent gain from the previous year, according to the report. By comparison, the median compensation for specialists rose 2.4 percent to $411,852. MGMA defines compensation as salary, bonuses, incentive payments, research stipends, honoraria, and profit sharing. It does not include retirement or health care benefits, automobile allowances, or expense reimbursements.

The median compensation for a family physician who performed obstetrics was $227,883; without obstetrics, the median was $221,418.

Halee Fischer-Wright, MD, the president and CEO of MGMA, said in a release that the study confirmed that compensation models have begun shifting from being purely based on productivity to ones that incorporate value.

“We hope to see physicians’ salaries remain healthy throughout this transition,” Fischer-Wright said.


Posted at 10:00AM Jul 28, 2015 by David Twiddy | Comments [0]

Thursday Jul 16, 2015

Survey shows rise in solo practice physician searches

The number of solo practices looking for new physicians or advanced practitioners rose last year, one of the largest physician recruiters says.

Physician search firm Merritt Hawkins in its annual review(www.merritthawkins.com) says 4 percent of the 3,120 search assignments conducted by itself and affiliated firms between April 1, 2014, and March 31, 2015, were for solo practices. This represents a sizable increase from the year before when solo practice assignments made up less than 1 percent of the company’s workload.

Physician-owned medical groups also made strides, making up 20 percent of search assignments, compared with 13 percent the year before, while those from hospitals fell from 64 percent to 51 percent. But the trend is still clearly with employed practice. Merritt Hawkins said 95 percent of its assignments during the review period were for employed positions, compared with less than half in 2004. Assignments from community health centers and academic positions also increased.

Family physicians continued to be the most frequent search assignment for the ninth year in a row, followed closely by internal medicine, psychiatrists, hospitalists, and nurse practitioners. The firm noted that advanced practitioners, a category combining nurse practitioners and physician assistants, would have been fourth on the list, up from fifth last year. Four years ago, neither made Merritt Hawkins’ top 20 assignments, either together or separately.

“Concierge” and other practice models where patients pay their physician directly for care without going through third-party payers, while gathering increasing attention from physicians, remained a tiny piece of the assignment mosaic. The company said it fielded only 25 assignments for concierge practices during the review period, down from 32 in the previous year.

After hitting a five-year high last year, the average base salary for family physician assignments during the study period fell slightly, declining from $199,000 to $198,000.

While policymakers have increasingly discussed the switch of reimbursement from fee-for-service to models based on quality and value, Merritt Hawkins said only 23 percent of its assignments included bonuses tied to quality metrics, down from 24 percent during the previous year. Fifty-seven percent of assignments still relied on relative value units (RVUs) for measuring physician productivity.


Posted at 10:26AM Jul 16, 2015 by David Twiddy | Comments [0]

Thursday Jun 11, 2015

Feds warn about potentially illegal medical director compensation

Federal investigators are warning physicians who serve as medical directors to make sure their compensation agreements aren't violating anti-kickback regulations.

The Department of Health and Human Services' Office of Inspector General (OIG) this week said it recently reached settlements with a dozen physicians across the country who had served as medical directors for various health care organizations. The agency said it determined those physicians' directorship compensation agreements were improper because they were tied to the individual physicians' volume or value of referrals and didn't reflect fair market value of the services they rendered – if they provided any services at all.

In some cases, the physicians also entered agreements that led to an affiliated hospital, health group, or other entity paying the salaries of the physician's office staff. While not paying the physician directly, these arrangements reduced the physicians' actual business expenses, so the inspectors claimed this compensation improper.

The OIG reminded physicians that a compensation arrangement is potentially illegal if any part of it compensates the physician for past or future referrals of federal health care program business. For more information, see "OIG compliance program guidance for individual and small group physician practices(oig.hhs.gov)" and "A roadmap for new physicians: avoiding Medicare and Medicaid fraud and abuse(oig.hhs.gov)."


Posted at 03:46PM Jun 11, 2015 by David Twiddy | Comments [0]

Wednesday Apr 22, 2015

Physician compensation rises but so do frustrations

Most primary care and other medical specialties saw a modest gain in overall compensation last year, although many physicians are still unhappy with the state of medicine.

More than 19,000 physicians in 25 specialties were surveyed for the Medscape Physician Compensation Report for 2015(www.medscape.com) released this week. It showed that the average compensation for primary care physicians held steady at $195,000 in 2014 while other specialties reported an average of $284,000. Family medicine led the gains for primary care, increasing 10 percent over 2013 to $195,000. Internal medicine and pediatrics each gained 4 percent to $196,000 and $189,000, respectively.

While the pay is up, only 47 percent of primary care physicians and 48 percent of family physicians said they felt they were fairly compensated, compared with half of specialists. Also, while almost three-fourths of family physicians surveyed said they would again choose medicine as a career if they had it to do over, less than a third said they would stick with family medicine.

The trend of physicians choosing to work for hospitals and other large health care groups continued with 63 percent of survey responders saying they were employed while 32 percent said they remained in private practice. Employed primary care doctors appeared to be trading some compensation for the security and fewer regulatory headaches of employment as they made an average of $189,000 versus the $212,000 earned by self-employed physicians.

The wage gap between male and female physicians appears to be shrinking, albeit slowly. Male physicians made an average of $284,000, or 24 percent more than female physicians ($215,000). The difference was 28 percent when Medscape measured in 2011. The researchers suggested much of the difference in compensation levels comes from female physicians typically working fewer hours and weeks and tending to go into lower-paying specialties such as obstetrics/gynecology or pediatrics.

There has been a lot of focus on physicians moving to alternative practice styles, but real-world results are mixed. Just 3 percent of surveyed physicians said they were in a concierge practice, which typically charges an annual retainer, and 5 percent said they were in a cash-only practice, down from 6 percent in 2013. Thirty-seven percent said they were participating in or planning to participate in an accountable care organization (ACO), which can reward physicians and allied health care groups for lowering costs and improving care.

Primary care physicians are apparently more open to these new practice models with 4 percent in concierge practices, 5 percent in cash-only practices, and 43 percent in or planning to join an ACO.

To learn more about some of these subjects, visit the following FPM topic collections:


Posted at 01:59PM Apr 22, 2015 by David Twiddy | Comments [0]

Tuesday Oct 14, 2014

Forewarned is forearmed: Using comparable compensation data in employment contract negotiations

For many employed physicians (and there are an increasing number of you), the annual rite of contract negotiations with payers has given way to the annual rite of contract negotiations with employers. One of the key elements in those negotiations is compensation.

The driving concern will be whether you are being compensated fairly, and solving that riddle means knowing whether the compensation you’re being offered is comparable to that of physicians in your region with similar skills and experience.

But, where can you find that information? One option is national medical specialty societies. For instance, the American Academy of Family Physicians has data on individual income (before taxes) of family physicians segmented by employment status, primary employer, practice size, number of years since residency, region, and primary location (i.e., metropolitan versus non-metropolitan).

Another option is data published by trade groups such as the Medical Group Management Association (MGMA(www.mgma.com)) and recruiting firms like Merritt-Hawkins(www.merritthawkins.com). Those data have their limitations, but to the extent that physicians’ employers are consulting them already, it is often useful for physicians to be aware of them too.

Knowing what other physicians in similar circumstances are earning is no guarantee that you will earn the same. However, as Kofi Annan, former secretary-general of the United Nations once observed, “Knowledge is power. Information is liberating.”

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 02:58PM Oct 14, 2014 by David Twiddy | Comments [0]

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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