MGMA-ACMPE details first findings of quality impact on doctor pay

Primary care physicians report that 3% of their pay is based on quality measures, while the figure is 2% for other specialties, according to a survey by MGMA-ACMPE, an association for practice managers. The figures are small now, but the organization said it is beginning to track them because they are expected to become a larger factor in how doctors get paid.

MGMA-ACMPE has issued annual compensation surveys for many years, but its study released in June, based on 2012 data, was the first to break out how much quality measures and patient satisfaction figured into pay. Physicians responding to the survey, which covered more than 60,000 doctors and other practitioners, said patient satisfaction “played a small role” in compensation.

The organization said it broke out quality and satisfaction’s effect on pay to highlight the importance of physicians and administrators working together to ensure that patients have the best experience possible, including the quality of clinical care and making sure wait times aren’t too long, said Todd B. Evenson, director of data solutions at MGMA-ACMPE.

“There should be a realization in the industry that as we move toward more value-based reimbursement, that the role of business operations of that medical group or health system, along with the role of the physicians providing clinical care, are more and more intertwined,” Evenson said.

Public and private health plans are promoting alternatives to fee for service, most notably accountable care organizations, that are expected to affect physician compensation.

For example, a survey of 39 insurers by Porter Research on behalf of Availity, a health information network in Jacksonville, Fla., found that 82% consider the development of new payment models a “major priority.” Twenty percent of the plans said at least half their business was supported by value-based payment models at the end of 2012. By the end of 2015, 45% of plans expect half their business to be supported by such models, according to the survey, released in May.

“Risk” payment arrangements

One plan, Humana, is including in its financial reports how many of its 180,000 employed and affiliated primary care practitioners have quality components in their payment. In its latest report, covering the quarter ending March 31, Humana said 4,100 employed primary care doctors and practitioners were in “risk” payment arrangements, down from 4,200 at the end of 2012. However, the number of contracted clinicians in risk arrangements went from 1,200 at the end of 2012 to 2,100 as of March 31, while 21,600 on that date were on a “path to risk,” up from 18,200. A path to risk means they are converting from fee for service to value-based pay.

Evenson said doctors should be ready for a rapid shift away from fee for service, and that doctors in large health systems are likely to be seeing that change already. An MGMA-ACMPE survey released in April found 40% of medical directors saying their pay was tied to quality metrics.

“Five years ago, 3% to 5% of a physician’s compensation would be driven by satisfaction and quality,” Evenson said. “Now, 10% to 20% is not that uncommon. But smaller organizations that haven’t seen that value-based reimbursement yet have brought the national average down to 2% to 4%. My expectation is, moving forward, we will continue to see growth in this area.”