How Are Doctors Paid? Learn the Incentives in Physician Compensation
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.
- 🏥 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.
- 💼 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.
- 🤔 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.
- 👥 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.
Outlines
📚 Value-Based vs. Volume-Based Physician Payment
Dr. Eric Bricker introduces a recent study from RAND Corporation and Harvard, published in the Journal of the American Medical Association, examining physician payment structures. The study focused on 31 physician practices owned by 22 hospital systems across various states. It revealed that 84% of primary care physicians and 93% of specialists were paid based on patient volume and services provided, rather than on quality or cost-effectiveness. The study also found that only 9% of primary care and 5.3% of specialist compensation was linked to quality and cost-effectiveness. Dr. Bricker discusses the implications of this fee-for-service model, which incentivizes patient volume over quality of care, and how it contrasts with the value-based payment models promoted by the government and insurance carriers.
🏥 Hospital Systems and Physician Payment Disparity
In the second paragraph, Dr. Bricker emphasizes the disconnect between the value-based payment models promoted by the government and insurance companies and the actual payment structures within hospital-owned physician practices. He points out that despite the push for value-based care, the compensation for primary care physicians and specialists is still largely volume-based, aimed at maximizing hospital revenue rather than improving patient outcomes or cost-effectiveness. Dr. Bricker also highlights the importance of watching what organizations do, rather than just listening to what they say, as the continued use of fee-for-service models indicates a lack of alignment with the stated goals of value-based care. He concludes by suggesting that the independence of physicians, with 50% not employed by hospitals, may offer a more promising avenue for innovation and quality-focused care.
Mindmap
Keywords
💡Value-based doctor pay
💡Fee-for-service
💡Relative Value Units (RVUs)
💡Volume-based incentives
💡Quality and cost effectiveness
💡Health system revenue
💡Hospital-owned physician practices
💡Specialist referrals
💡Payment innovation
💡Independent physician practices
💡Window dressing
Highlights
Dr. Eric Bricker discusses the topic of value-based doctor pay, which he argues is often just 'window dressing'.
A new article from RAND Corporation and Harvard published in the American Medical Association journal on January 28th, 2022 is being reviewed.
The study examined 31 physician practices owned by 22 different hospital systems across multiple states to understand pay structures for primary care doctors and specialists.
84% of primary care physicians and 93% of specialists were found to be paid based on the volume of patients and services, not outcomes.
Payment structures are often measured by Relative Value Units (RVUs), which incentivize doing more services rather than focusing on cost-effectiveness.
Only 9% of primary care compensation and 5.3% of specialist care were based on quality and cost-effectiveness.
Approximately 50% of doctors in the U.S. work for practices owned by hospitals, indicating a widespread issue with current compensation models.
The article concludes that despite value-based reimbursement incentives, compensation is still dominated by volume-based incentives to maximize health system revenue.
The disconnect between government and insurance carrier payment models and actual physician compensation practices is highlighted.
The article suggests that the current fee-for-service model is still dominant and not aligned with value-based care initiatives.
A quote from a hospital consultant's newsletter emphasizes the pressure on maximizing specialist referrals over other goals within hospital systems.
The leader of a hospital-owned physician group admits that the focus on specialist referrals limits innovation in payment models.
Dr. Bricker emphasizes the importance of watching what hospitals and practices do rather than just listening to their stated values.
The fact that 50% of doctors are still independent may offer an alternative to the hospital-owned practice models and their compensation structures.
The importance of independence in physician practices to potentially foster a shift towards cost and quality-based care is noted.
Dr. Bricker concludes by advocating for the need to observe actual practices over stated intentions in the healthcare industry.
Transcripts
hello this is dr eric bricker and thank
you for watching a health care z today's
topic is
value-based doctor pay
equals window dressing
that's right what do i mean there is a
brand spanking new article
from rand research and development very
famous think tank out in santa monica
california
and harvard
that was published on january 28th of
2022 so this is hot off the presses in
the journal the american medical
association now i did a video last week
reviewing an article from the journal of
the american medical association so like
jama is on fire they're like very much
focused on like health care finance
issues right now so i want to bring with
you this amazing article so
these researchers looked at 31 physician
practices
that were owned by
22 different hospital systems across
multiple states
and they wanted to say okay well what
type of pay structures do the primary
care doctors and specialists have at
these physician practices that are owned
by hospital systems and this is what
they found they found that the pay
incentivized
patient
volume
more specifically
84
of the primary care physicians were paid
based upon the volume of patient and
services that they
saw likewise 93 of the specialists were
paid based upon the volume of patients
that they saw and the volume of
procedures that they did now within the
hospitals and the practices themselves
they measure that with these rvus
relative value units and i'll leave a
link in the show notes explaining in
more detail what an rvu is so in other
words they're paid for doing stuff
they're not paid for outcomes they're
not paid for being cost effective
they're paid for doing services that's
why it's called fee for service now i
want to tell you right now i'm not 100
against some degree of physician
competition compensation being based on
doing stuff i mean you can't have a
doctor just sitting there collecting a
salary not doing anything right so to a
certain extent just like in any other
job to a certain extent like your pain
needs to be based upon you actually like
doing something as opposed to just
sitting there right so some of it has to
all right fine now
let's look at the amount of pay that the
physicians received based upon being
high quality and cost effective in other
words what portion of their compensation
was based upon
quality and cost effectiveness well the
rand study looked at that too and they
said look
nine percent of primary care
compensation was based upon
quality and cost effectiveness and only
5.3
of specialist care was based on quality
and cost effectiveness what's that
called
not that much now keep in mind
this is for phys they look at physician
practices that were owned by hospital
systems
now
50 i'll leave a link in the show notes
50
of doctors in america now work for
physician practices that are owned by
hospitals okay so it's half all right so
if you go to see a doctor like there's a
50 50 chance that they work in a
practice that's owned by a hospital
system that's called like a high
percentage okay now
the article makes a very interesting
conclusion and i'm gonna read it
straight from the article so let me get
so
they said
the results of this cross-sectional
study suggest that pcps and specialists
despite receiving value-based
reimbursement incentives from payers
the compensation of health system
primary care physicians and specialists
was dominated by volume-based incentives
designed to maximize health system
revenue i'm going to read that last part
again
pcps and specialists
compensation was dominated by
volume-based incentives designed to
maximize health system revenue so
there you have it
from the researchers in
the journal of the american medical
association again one of the most
preeminent journals in the world they
have a very vigorous review board
interestingly jama has a new
editor-in-chief who has also done a lot
of research about financial conflicts of
interest in publications and financial
conflicts of interest with doctors so
here you have the editor of jama now who
is very attuned to financial issues in
health care and they've published a very
serious article about the implications
of fee for service still being the
dominant mode of payment for doctors why
is this important i got a picture to
show that okay so we've got the federal
government and state medicaid programs
and health insurance carriers that are
saying look we've got all these
value-based payment and alternative
payment models etc etc etc we call this
payment innovation that's going to
hospitals okay fine so you got it the
point of this article is that the
relationship between the doctors and how
the hospitals and how they be doctors is
not value-based it is not consistent
with the way that the government the
insurance carriers are trying to
compensate the hospitals instead you've
seen that i've gone around there's a big
x here at this area they've basically
blocked that compensation uh
relationship between the hospitals and
the doctors and instead they're doing an
end around with still fee for service
volume based reimbursement
why is that important how the government
insurance company like how they pay the
hospital that's not really what matters
what matters is is how the doctor
performs patient care it's this
relationship here between the doctor and
the patient so as far as that
relationship between the doctor and the
patient goes it's still a
fee-for-service environment it is not a
volume-based environment and those
doctors are still incentivized for
volume for doing stuff for rvus and not
for quality and not for cost
effectiveness so essentially all this
stuff that's why i said window dressing
all this stuff up here between the
government and the insurance carriers
and the hospitals that's just window
dressing when it comes to the actual uh
behaviors and decisions by doctors with
their patients let's just call a spade a
spade that art this article points out
that disconnect now i want to read you a
quote from the gist
newsletter that i've mentioned before
it's a fantastic newsletter i'll leave a
link to it in the shows and this is by
hospital consultants and they published
a quote by a leader at a physician
practice owned by a hospital that is
very much in line with this research
article i'm going to go to that as well
so we're doing we're doing multimedia
here so let me actually read this quote
from a leader at a physician practice
that's owned by a hospital
it's very interesting the honest answer
is that we need different things from
our primary care docs and specialists
and if we're all in one group tied to
the system i.e the hospital system the
pressure will always be there to
maximize specialist referrals over other
goals it undoubtedly limits our ability
to innovate there you have it
the quote-unquote honest answer that's
what the leader of that now keep in mind
this was a this was said anonymously i
don't know if he or she would like put
their name out there in terms of saying
this but here you have the leader of a
hospital um physician group
essentially saying the same thing that
look that specialist referrals is the
ultimate goal of the physician practice
and that blocks innovation like payment
innovation okay so fine
well it's a the reason i'm telling you
all this is because it's important for
us to follow the andrew carnegie quote
of not listening to what people say but
watching what they do and what these
practices and hospitals have done is
they have continued to pay their
physicians the same way they have in the
past in other words it has not changed
okay so we need to watch what they do
not just listen to what they say now
what else is important about this i'm
not just here to present problems
without solutions that mean 50 of
doctors are employed by hospitals that
means that 50 of doctors are still
independent so arguably
now
having an independent physician doesn't
guarantee that they'll do things based
on cost and quality and not based upon
volume but i'm just saying obviously i'm
biased because i'm the chief medical
officer of an independent physician
practice it happens to be a virtual
practice but it's a practice nonetheless
that
we're independent it's important to be
independent it's important not to have
these types of relationships set up
and that's my point for today thank you
for watching a healthcare z
関連動画をさらに表示
5.0 / 5 (0 votes)