Doc pay method may deter shift to value

Shifting doctors to pay-for-value models will not be simple.

A recent report from the American Medical Association looked at proposed payment methods in models such as accountable care organizations, episodic bundles of care and risk-adjusted global budgets, to see how they line up with current approaches for compensation.

[See also: Doctors wary of value-based models]

What was found was that the way physicians are compensated now – through a variety of methods – may not align with the way incentives are structured in pay-for-value models.

“What is clear is that payment filters down to the physician in different ways that depend on the characteristics of a physician’s practice,” said Carol Kane, a senior economist at the AMA, in the report. “Changed incentives at the practice level may be felt differently at the physician level depending on what compensation methods are in place.”

Compensation varies depending on whether a physician is an owner of or employee in a practice, the type of practice as well as specialty. Although more than one-half of non-solo physicians received all or the largest share of their pay from salary, almost one-third said that compensation was based in wholly or in large part on their personal productivity.

And salaried is not the same as employed, Kane noted in the report. Although 76.1 percent of employed physicians received a salary, 44 percent of physicians with an ownership stake in their practice did as well. Also, 54.2 percent of owners and 46.9 percent of employed physicians had compensation that included pay based on their personal productivity.

According to the report, which is based on data from the AMA’s 2012 Physician Practice Benchmark Survey, 51.8 percent of the polled physicians said they were compensated through a single payment method; 30.3 percent by two methods and 17.9 percent by three or four. The distribution is similar for physicians who are owners and employees.

The variation in compensation arrangements “… suggests that it may be difficult to align practice level incentives that encourage judicious use of resources with physician level incentives that do not,” the report concluded.