Compensation: Are Physicians Better Off Now Than 6 Years Ago?

Carol Peckham


April 01, 2016

In This Article

Specific Payment Models Over 5 Years

Cash-Only and Concierge Practices

Despite considerable enthusiasm, cash-only and concierge practices are still not significant payment models.[11] In fact, as Medscape compensation surveys have revealed, concierge practices have stayed at around 3% for the past 3 years. The proportion of cash-only practices went up slightly this year (6%) compared with last year (5%).

Travis Singleton commented, "In lieu of changing to concierge medicine, many physicians have opted out of traditional private practice to become employees. That is their escape hatch from the pressures of private practice. However, as reimbursement systems become more arcane and more value-driven, we anticipate that a growing number of physicians will embrace the concierge model. We have seen a continual increase, albeit a small percentage, of physicians migrating toward a direct-pay model. Whether truly concierge or just removing a third-party payer from the equation, the driving forces tend to be the same. Urgent care delivery systems have also given a safe haven for those providers who might otherwise have chosen concierge or direct-pay practices.

Accountable Care Organizations

In early 2015, Sylvia Burwell, secretary of the Department of Health and Human Services, unveiled a timetable for moving Medicare further from fee-for-service to pay-for-performance. Burwell said that Medicare would funnel 30% of reimbursement to physicians and hospitals through alternative payment models, such as accountable care organizations (ACOs) and medical homes, by 2016, and 50% by 2018.

According to the Medscape survey, current and future participation in ACOs is indeed still increasing, at 39% this year compared with 37% in last year's report. Thirty-seven percent of specialists participate or plan to participate this year in ACOs, which is much lower than PCP participation (45%). More PCPs (39%) also reported being in ACOs this year than in last year's report (35%). According to some experts, as of late 2015, the results on ACOs still leave questions as to whether meeting quality metrics translates into meaningful improvement in patient care. In addition, they don't seem to have reduced costs at all.[12,13]


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