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Monday Apr 01, 2019
High-deductible Plans Give 'Prevention' a New Meaning
Monday Feb 18, 2019
Better Health Care for Veterans Requires Better Payment
Ada Stewart, M.D., who cares for active-duty soldiers and veterans as a U.S. Army Reserve physician, as well as in her civilian practice, writes about the urgent need for payment and workforce reform in the nation's veterans health care system.
Monday Oct 08, 2018
We're Making Progress on the Issues That Matter to FPs
Friday Sep 07, 2018
Why Does Equal Pay for Equal Work Still Elude Us?
Wednesday Apr 11, 2018
More Investment in Primary Care Would Help Mothers, Babies
Monday Sep 11, 2017
Everyone Should Realize FPs Are the Quarterbacks of Medicine
Tuesday Feb 07, 2017
CPC+ Laying Groundwork for Value-based Payment
Tuesday Jan 03, 2017
Direct Primary Care Is a Sensible Workforce Solution
Wednesday Dec 23, 2015
End of Medicare Bonuses Underlines Need for New Payment Models
More than just the calendar year will end on Dec. 31. The New Year also will mark the end of the Primary Care Incentive Program (PCIP).
The PCIP, created in 2010 as part of the Patient Protection and Affordable Care Act, pays family physicians and other primary care providers bonuses equal to 10 percent of the amount Medicare paid them for primary care services if they met certain conditions. This bonus was an overdue step toward recognizing the value of primary care.
The program paid $664 million to primary care practices in 2012, but how much it will be missed depends somewhat on whom you ask. A survey of primary care physicians found that half were unaware of the program's existence.(kaiserfamilyfoundation.files.wordpress.com) Some physicians "boutique" their practices, limiting their number of Medicare patients. But many practices in rural and underserved areas can't do this, and they benefited greatly from the bonus payments. Practices with large Medicare panels certainly will feel the hit. Qualifying primary care physicians received an average of nearly $4,000 a year.
Although the AAFP and other primary care advocates fought for an extension of the program, Congress showed little interest in prolonging a bonus program based on the fee-for-service model. As we have seen in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) -- the law passed earlier this year that repealed the flawed Medicare sustainable growth rate formula -- legislators are more interested in linking increased physician payments to certain quality and performance standards.
If you haven't already, I strongly encourage you to start making yourself familiar with the alternative payment models and the merit-based incentive payment system (MIPS) described in the new law. By 2019, all physicians participating in Medicare will fall into one category or the other.
MIPS, while attempting to promote quality and added value, still is based on fee-for-service. And as we have seen, that model continues to be a popular target for spending cuts. A multi-year federal budget agreement led to a 2 percent cut to Medicare payments in 2013 and further incremental reductions for several years, and Congress allowed the Medicaid parity program -- a provision of the ACA that raised Medicaid physician payments in line with Medicare -- to expire in December 2014.
The 2016 physician fee schedule called for a modest 0.5 percent increase in the physician payment conversion rate. However, other legal mandates made even that minimal increase too tall a task for CMS because it failed to identify and adjust a required percentage of overvalued CPT codes. As a result, the Medicare physician fee schedule will see a fractional decrease in the conversion factor in 2016, rather than a half-percent increase.
What it boils down to is that alternative payment models are the path forward that will provide stability and give our practices the greatest opportunity to thrive. One-third of family physicians already are pursuing value-based payments.
The AAFP recently submitted detailed responses to 126 questions as part of a CMS request for information on how to implement new payment models associated with MACRA. Early in 2016, the Academy will be rolling out materials that will help family physicians better understand the choices, deadlines and challenges that MACRA presents. Stay tuned.
Robert Wergin, M.D., is Board Chair of the AAFP.
Monday Aug 17, 2015
America's Most Wanted: Family Physicians Again Top Search Firm's Wish List
We're No. 1.
For the ninth straight year, "family physician" was the most highly recruited role in U.S. health care, according to national health care search firm Merritt Hawkins.
© 2015 Tiffany Matson/AAFPResidency exhibitors talk with medical students during the 2015 National Conference of Family Medicine Residents and Medical Students. The recent event in Kansas City, Mo., attracted record-setting attendance, including more than 1,200 medical students and representatives from hundreds of family medicine residency programs.
Merritt Hawkins publishes a review each year of the more than 3,100 search and consulting assignments it conducts on behalf of its clients. In its 2015 report(www.hcpro.com), the firm noted it sought to fill 734 openings in family medicine from April 1, 2014, to March 31, 2015. Internal medicine was a distant second at 237 openings. It was the ninth consecutive year that general internist ranked second behind family physician, a fact that highlights "the continued nationwide demand for primary care physicians as team-based care and the population health management model continue to proliferate," according to the report.
The report's authors noted that primary care physicians top the list of most-in-demand doctors in part because of the key role we play in patient management and care coordination. Specifically, they likened us to point guards on a basketball team. Patients need to see us first so we can coordinate their care appropriately. We can provide comprehensive care and refer patients to expensive subspecialist care only when needed. Like a point guard, family physicians see the big picture, not merely focusing on a single issue or area.
The report pointed out that primary care physicians are being rewarded for "the savings
they realize, the quality standards they achieve and for their managerial role" in newer models of care.
"That, at least, is the aspiration of these emerging models," said the report.
"In systems where volume/fee-for service still prevails," the report added, "primary care physicians remain the keys to patient referrals and revenue generation." In fact, a 2014 Merritt Hawkins survey found that family physicians generate, on average, more than $2 million a year for their affiliated hospitals.
I don't know about you, but I'd rather be a point guard who is looked to as the leader of a health care team than as a mere referral factory.
"Regardless of which model is in place (or a hybrid of the two) primary care physicians are the drivers of cost, quality and reimbursement and therefore remain in acute demand," the report said.
And that brings us to income.
For the jobs Merritt Hawkins sought to fill, family physicians had an average starting salary of $198,000. Overall, according to the firm, family physician income has increased more than 11 percent since its 2010-11 survey.
Meanwhile, a recent report by the Medical Group Management Association(www.medpagetoday.com) (MGMA) that was based on a survey of nearly 70,000 physicians reported a median salary of $227,883 for family physicians who provide maternity care and $221,419 for family physicians who do not. MGMA reported a median salary of $241,273 for primary care physicians, which was an increase of 3.56 percent compared with the previous year's figure. The same report found that median pay for subspecialists rose 2.39 percent to $411,852.
So although primary care physician income still lags behind that of our subspecialty colleagues, it is increasing at a faster rate. Since 2012, primary care physicians' income increased 9 percent, while subspecialist pay increased 3.9 percent during the same period, according to MGMA.
Part of the reason for the change is the shift to value-based contracts. According to MGMA, 11 percent of primary care payments came from value-based contracts in 2014, up from 3 percent in 2012. Halee Fischer-Wright, M.D., a pediatrician and MGMA’s chief executive officer, said in a recent interview with Forbes(www.forbes.com) that the figure could grow to more than 30 percent within three years.
It's worth noting that Merritt Hawkins reported decreasing incomes for the positions it sought to fill in several subspecialties. Otolaryngology was down 10.2 percent, physiatry dropped 13.8 percent, urology lost 18.3 percent, and noninvasive cardiology declined a whopping 34.2 percent. OB/Gyn (-4.2 percent), general surgery (-4.2 percent), hematology (-7.2 percent) and pulmonology (-7.5 percent) also saw declines.
Our country has a critical need for primary care physicians. To convince more medical students to pick primary care, that payment gap will have to continue to shrink.
Emily Briggs, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.
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