2013 Congress of Delegates

Misuse of Salary Data, Coding Top List of Practice Enhancement Concerns

September 27, 2013 04:45 pm David Mitchell San Diego –

When family physicians at a hospital-owned clinic in Malden, Mass., found out they were being paid far less than their internal medicine colleagues, they weren't happy. In fact, three out of 16 quit.

Ajoy Kumar, M.D., alternate delegate from St. Petersburg, Fla., testifies during the Reference Committee on Practice Enhancement on the misuse of physician compensation data.

Not, however, Patricia Sereno, M.D., of Stoneham, Mass. She wanted answers … and change.

So Sereno went to her employer and asked why family physicians were making $15,000 less in base salary and were being paid less per relative value unit (RVU) than general internists. Hospital officials replied that compensation was based on data from surveys from the Medical Group Management Association (MGMA).

"I said, 'I want to see that data,'" Sereno said in an interview with AAFP News Now. "They presented it to me, and sure enough, the data said internal medicine physicians earn more."

But Sereno didn't trust the data. Why, she thought, would internal medicine physicians make much more than family physicians for providing the exact same services? Sereno, a delegate to the AAFP Congress of Delegates, decided to bring up the topic at the 2012 Town Hall meeting. At the time, she thought she was just one physician dealing with an isolated incident.

Story Highlights
  • Some employers are using data from the Medical Group Management Association (MGMA) as a basis for physician compensation, exacerbating pay discrepancies for family physicians.
  • Delegates referred a resolution calling for the Academy to engage with MGMA, the American Hospital Association and others to seek a solution that pursues equal compensation for equal services by primary care physicians, to the Board. 
  • Delegates also asked for help with ICD-10, other coding issues and payment for obesity-related services.

She wasn't.

In fact, the Florida delegation introduced a resolution on the topic during this year's Reference Committee on Practice Enhancement on Sept. 23 at the Congress of Delegates here. The resolution, which ultimately was referred to the Board of Directors, calls for the Academy to engage with MGMA, the American Hospital Association, the Federal Trade Commission and other stakeholders to seek a solution that pursues equal compensation for equal services by primary care physicians. The resolution also calls on the Academy to develop additional resources to educate members about this issue and help them in negotiations to avoid such discrepancies in pay.

According to Ajoy Kumar, M.D., a Florida alternate delegate from St. Petersburg, the Florida AFP sent the resolution forward after a member, who was being paid up to 34 percent less per RVU than general internal medicine physicians for performing the exact same services, brought the problem to the attention of the chapter.

"If the data is inaccurate," said Kumar, "how can you use that as the basis for physician compensation?"

In an attempt to help Sereno after last year's Town Hall meeting, Academy staff met with the MGMA, and Kent Moore, the AAFP's senior strategist for physician payment, then drafted a memo to AAFP chapters to make them aware of the issue and a letter template to use for negotiating with employers.

The memo points out several limitations in the MGMA data, including that specialty is self-selected by survey respondents, and it is possible that some internal medicine sub-specialists report themselves as general internists.

MGMA Data May Cause

In an attempt to clarify problems with how salary data distributed by the Medical Group Management Association (MGMA) is being interpreted by employers, Kent Moore, the AAFP's senior strategist for physician payment, drafted a memo and a letter template on the issue earlier this year.

According to Moore, physicians may run afoul of antitrust laws if they compare compensation with competing physicians, and they should consult with their legal counsel. In addition, said Moore, employed physicians should be aware if employers are using MGMA data as a basis for compensation.

There are other reasons why general internal medicine compensation per relative value unit (RVU) may be higher than the corresponding family medicine compensation, said Moore.

  • Many private payers use multiple conversion factors that vary by, among other things, types of service. If general internists provide a different mix of services than family physicians, they may be compensated more.
  • The payer mix also may affect total compensation. For example, if family physicians treat a higher percentage of Medicaid patients, their compensation may be lower, even if they provide exactly the same services.
  • Some medical groups are able to negotiate higher compensation rates from private payers than other groups; if general internists disproportionately belong to such groups, they may benefit from higher compensation.

Furthermore, MGMA has said that its reports are "presented solely for the purpose of informing readers of ranges of medical practice compensation, charges and revenue" and may not be used "for the purpose of limiting competition, restraining trade, or reducing or stabilizing salary or benefit levels." MGMA also notes that its surveys are not an attempt to provide "legal, accounting or professional advice that may be construed as specifically applicable to individual situations."

Sereno told members at the Sept. 22 Town Hall meeting here that, armed with information and support from the Academy, she went back to her employer, which raised her salary to the level of its general internal medicine physicians.

Coding Help

Delegates also adopted a resolution from the Reference Committee on Practice Enhancement that calls on the AAFP to request that HHS provide funding to CMS to contract with Medicare carriers to provide training to physicians and their staff members on how to use ICD-10-CM coding correctly before the Oct. 1, 2014, implementation deadline.

"ICD-10 is far too complex to expect compliance without significant investment in physician education," Virginia alternate delegate E. Mark Watts, M.D., of Vinton, testified during the reference committee hearing.

The AAFP already has developed resources to assist physicians with transitioning to the new codes, but the reference committee said in its report that physicians need as much help as possible with this difficult issue.

A resolution calling for the Academy to encourage changes in CMS determinations of coding so that all medical information entered by a health care team during a patient visit will be used to determine the submitted code also met with a favorable response from the COD, which adopted the resolution.

"Everything that happens with team care should count toward your final code," said Janice Gomersall, M.D., alternate delegate from Missoula, Mont., during the reference committee hearing.

Obesity Services

Delegates also adopted a substitute resolution that calls on the Academy to support payment for obesity-related services by all payers. Sarah Fessler, M.D., a delegate from Riverside, R.I., said the resolution was intended to reaffirm and strengthen existing Academy policy.

Earlier this year, the AMA House of Delegates, with support from the AAFP delegation, adopted a resolution that said obesity should be recognized "as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention." (Then) AAFP President Jeff Cain, M.D., testified at the time that classifying obesity as a disease would help convince health plans to pay for treatment.

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