Primary Care Physician Incentives in Medical Group Practices

Pedersen, Craig A.; Rich, Eugene C.; Kralewski, John E.; Feldman, Roger; Dowd, Bryan E; Bernhardt, T

doi:10.1001/archfami.9.5.458

Cited by 13 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of course, depending on the financial underpinnings and business model of the practice, substantial incentive pay (i.e., "bonus") may augment the base income and re-orient the physician incentives from "salary" to one of the alternative frames discussed. 49 In group practices in heavily capitated, managed care environments, bonus payments for salaried physicians based on group practice "net revenue" was a common incentive system 49 and proved an effective way to reduce cost per patient. 50 In predominantly FFS environments, salaried physicians are often rewarded for maximizing their visit-based productivity, thereby mimicking FFS payment incentives.…”

Section: Salary: Physician As Employeementioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

View full text Add to dashboard Cite

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (feefor-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.KEY WORDS: primary care; reimbursement; health care delivery.

show abstract

Section: Salary: Physician As Employeementioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

View full text Add to dashboard Cite

show abstract

“…Counterbalancing these incentives are the theoretical incentives to invest in medical care that can decrease long‐term medical costs through disease prevention and early treatment. Practices reporting a larger proportion of income from capitated contracts are more likely to base primary care physician compensation on measures of quality and utilization 25 . Unfortunately, the incentives to make these investments are mitigated by the relatively high rates of turnover, as patients move from plan to plan, precluding long‐term financial benefit 26 .…”

Section: Capitation and The Shifting Locus Of Riskmentioning

confidence: 99%

“…Practices reporting a larger proportion of income from capitated contracts are more likely to base primary care physician compensation on measures of quality and utilization. 25 Unfortunately, the incentives to make these investments are mitigated by the relatively high rates of turnover, as patients move from plan to plan, precluding long-term financial benefit. 26 Society's financial risk is minimal in the short term.…”

Section: Capitation and The Shifting Locus Of Riskmentioning

confidence: 99%

The future of capitation The physician role in managing change in practice

et al. 2001

View full text Add to dashboard Cite

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances that protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.KEY WORDS: capitation; physician reimbursement; physician organization; physician financial risk; universal health care access.J GEN INTERN MED 2001;16:250±256.

show abstract

“…This is not the case for Norwegian salaried physicians, who have no economic incentives associated with referral. A study of American health organizations has shown that only 17% of primary physicians were salaried, without a bonus associated with patients' utilization of health services [14]. We know of only one American study in which purely salaried physicians are compared with other physicians in health organizations [15].…”

Section: Literature Reviewmentioning

confidence: 99%

Better primary physician services lead to fewer hospital admissions

et al. 2006

View full text Add to dashboard Cite

The aim of the study was to examine whether improved quality of primary physician services, measured by patient satisfaction, leads to fewer admissions to somatic hospitals. We studied differences in hospital admissions at the municipality level in Norway. In addition to the standard explanatory variables for use of hospitals--gender, age, socio-economic status and travelling distance to the nearest hospital--we also included a measure of patient satisfaction with primary physician services in the municipality. Data on patient satisfaction was obtained from an extensive questionnaire survey of 63,798 respondents. We found a statistically significant negative relationship between patient satisfaction and the number of hospital admissions. This conclusion was robust with regard to the empirical specification, and the effect was large.

show abstract

Primary Care Physician Incentives in Medical Group Practices

Cited by 13 publications

References 21 publications

US Approaches to Physician Payment: The Deconstruction of Primary Care

US Approaches to Physician Payment: The Deconstruction of Primary Care

The future of capitation The physician role in managing change in practice

Better primary physician services lead to fewer hospital admissions

Contact Info

Product

Resources

About