In response to the shift from traditional fee-for-service payment towards new value-based payment models, the American Medical Association (AMA) published a study on how doctors were compensated.
The AMA is worried that these new value-based initiatives will not distribute payments appropriately because not all physicians are paid by their employing entity based on their performance.
In the current, as well as the new payment models, payments from insurers generally flow to a physician practice or to an ACO or similar entity which then redistributes those payments to the provider/practice.
All physicians, except those in solo practice, were asked whether they received compensation from their practice through one of the following four methods:
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Base salary (salary);
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Compensation based on personal productivity;
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Compensation based on practice financial performance; and
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Bonus based on factors other than personal productivity and practice financial performance (bonus).
The data used is from the AMA’s 2012 Physician Practice Benchmark Survey (PPBS).
Solo practice physicians were excluded from this series of questions because regardless of what they call their compensation, it is directly related to personal productivity and practice financial performance. Physicians were allowed to select multiple methods and also could provide a fill-in response (other). Physicians who selected multiple methods were asked which one of those accounted for the largest share of their income and for an estimate of that share.
According to the AMA’s published results, “The data suggest that there is no ‘one size fits all’ characterization of payment methods. Over 53% of non-solo practice physicians received all or the largest share of their compensation from salary. Approximately 32% received all or the largest share of their compensation based on personal productivity.
Not surprisingly, these statistics vary by specialty. Each specialty has it’s own unique revenue stream and multi-specialty practices tend to have a greater number of physician employees.
Approximately 80 percent of physicians who were in
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faculty practice plans,
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directly employed by a hospital, or
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in the “other” practice type category
said that they were compensated exclusively by salary, or that salary contributed the largest share to their compensation.
The PBBS report goes into greater detail and breaks down the four types of compensation in several broad specialties for comparison. Specialties include:
Pediatrics
Psychiatry
Surgery Surgical Subspecialties
Radiology
Anesthesiology
Internal Medicine Subspecialties
Family Practice
Emergency Medicine
Internal Medicine
Obstetrics/Gynecology
Thanks to Bill Finerfrock, Matt Reiter, and Zhaneta Mansaku for contributing this article.
