How Are Doctors Paid? Learn the Incentives in Physician Compensation

AHealthcareZ - Healthcare Finance Explained
5 Feb 202208:58

Summary

TLDRIn this 'A Healthcare Z' video, Dr. Eric Bricker discusses a recent study revealing that despite value-based reimbursement incentives, physician compensation is still largely volume-based, maximizing health system revenue rather than focusing on quality and cost-effectiveness. The study, published in the Journal of the American Medical Association, analyzed 31 physician practices and found that 84% of primary care physicians and 93% of specialists are paid based on patient volume and procedures performed. Only a small percentage of their compensation is linked to quality and cost effectiveness, highlighting a disconnect between government and insurance initiatives and actual physician incentives.

Takeaways

  • 📰 The script discusses a new article from RAND Corporation and Harvard published in the Journal of the American Medical Association on January 28, 2022, focusing on value-based doctor pay.
  • đŸ„ The research analyzed 31 physician practices owned by 22 different hospital systems and found that 84% of primary care physicians and 93% of specialists were paid based on patient volume and services provided, not on outcomes.
  • đŸ’Œ The compensation structure is primarily fee-for-service, meaning doctors are paid for the quantity of services rendered rather than the quality or cost-effectiveness of care.
  • 🔱 Only 9% of primary care physician compensation and 5.3% of specialist compensation were based on quality and cost-effectiveness, indicating a minimal focus on these aspects.
  • 🌐 Half of the doctors in America work for practices owned by hospitals, which is a significant portion of the healthcare system.
  • 📉 The article concludes that despite value-based reimbursement incentives, compensation for primary care physicians and specialists is still dominated by volume-based incentives aimed at maximizing health system revenue.
  • đŸ€” The speaker questions the effectiveness of value-based payment models when the actual compensation for doctors does not align with these models, calling it 'window dressing'.
  • 💡 The script highlights the importance of observing actions rather than words, suggesting that despite claims of value-based payment, the actual compensation practices have not changed significantly.
  • đŸ‘„ A quote from a hospital-owned physician practice leader suggests that the pressure to maximize specialist referrals can limit innovation in payment models.
  • 🏆 The speaker advocates for the independence of physicians, implying that independent practices may be more likely to focus on quality and cost-effective care rather than just volume.
  • 📈 The script concludes by emphasizing the importance of watching what healthcare systems and practices actually do in terms of physician compensation, rather than just listening to their stated goals.

Q & A

  • What is the main topic discussed by Dr. Eric Bricker in the video?

    -The main topic discussed is value-based doctor pay and how it often equates to window dressing, with a focus on a new article that reveals most physician compensation is still volume-based rather than based on quality and cost-effectiveness.

  • What is the source of the article Dr. Bricker references?

    -The article is from RAND Corporation and Harvard, published in the Journal of the American Medical Association on January 28th, 2022.

  • How many physician practices did the researchers examine in their study?

    -The researchers examined 31 physician practices owned by 22 different hospital systems across multiple states.

  • What percentage of primary care physicians were found to be paid based on the volume of patients and services they saw?

    -84% of primary care physicians were found to be paid based on the volume of patients and services they saw.

  • What does the term 'RVUs' stand for, as mentioned in the script?

    -RVUs stands for Relative Value Units, a measure used to determine how much physicians are paid for the services they provide.

  • What percentage of primary care compensation is based on quality and cost-effectiveness according to the RAND study?

    -According to the RAND study, 9% of primary care compensation is based on quality and cost-effectiveness.

  • How does the current compensation system for physicians affect the relationship between doctors and their patients?

    -The current compensation system, which is largely fee-for-service and volume-based, incentivizes physicians to perform more services rather than focusing on quality and cost-effective patient care.

  • What does Dr. Bricker suggest is the impact of the disconnect between hospital compensation and physician compensation on patient care?

    -Dr. Bricker suggests that the disconnect leads to a continued focus on volume-based reimbursement for physicians, which can limit innovation and does not align with value-based care principles.

  • What is the significance of the quote from the leader at a physician practice owned by a hospital?

    -The quote highlights the internal pressure within hospital-owned practices to maximize specialist referrals, which may override other goals such as innovation and value-based care.

  • What does Dr. Bricker recommend as an alternative to the current compensation system for physicians?

    -Dr. Bricker recommends the importance of independence for physicians, suggesting that independent practices may be better positioned to prioritize cost and quality over volume.

  • What is the role of the new editor-in-chief of JAMA in relation to the discussed topic?

    -The new editor-in-chief of JAMA has a background in researching financial conflicts of interest in publications and with doctors, which makes the publication of the serious article on physician compensation and fee-for-service more significant.

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Transcripts

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Étiquettes Connexes
Healthcare FinanceValue-Based PayFee-for-ServicePhysician PracticesHospital SystemsQuality IncentivesCost-EffectivenessMedical ResearchAMA JournalHealthcare Reform
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