Observing Effects of the ACA on Primary Care Physician, Specialist Compensation
A recent study published in JAMA Network Open examined that since the Affordable Care Act (ACA) went into effect, compensation for both primary care providers (PCPs) and specialty physicians has increased.
“Since the implementation of the ACA, numerous factors may have affected physician compensation, including increased emphasis on alternative payment models and discounted insurance payments from health exchanges,” said the authors.
Walter R Hsiang, BS, Yale School of Medicine, Yale University, New Haven, CT, and colleagues conducted a study in order to determine how overall physician compensation has changed and how PCP compensation has changed relative to specialist compensation since the ACA was passed.
The researchers used data from a voluntary physician compensation survey conducted by the Medical Group Management Association (MGMA) which comprises more than 20,000 physicians from private practices, hospitals, academic apartments, and other organizations. Mr Hsiang and colleagues also calculated the change in the specialist premium—the gap between compensation for primary and specialist care.
“From 2008 to 2017, specialist compensation increased by a weighted mean (SD) of 0.6% (1.2%) per year, from $378 600 to $399,300, whereas primary care compensation increased by 1.6% (2.2%) per year, from $214,100 to $247,300,” found the researchers. “The specialist premium declined during this period, from $164,500 in 2008 to $152,000 in 2017, or from 77% to 61%.”
The researchers go on to say that even though the ACA has expanded insurance to millions of Americans, many patients still face issues with accessing primary care because of Medicaid’s low reimbursement rates. The authors suggest that a straightforward financial adjustment, such as a reinstatement of PCP fee increases, could address the issue. Another suggestion is that private payers play a more significant role by matching or administering Medicaid fee bumps in their own programs.
“As we head into another cycle of potential major health care reform, policy makers should recognize that physician compensation will remain a significant concern and that differences in compensation between PCPs and specialists will matter,” concluded Mr Hsiang and colleagues.
—Edan Stanley
Reference:
Hsiang WR, Gross CP, Maroongroge S, Forman HP. Trends in compensation for primary care and specialist physicians after implementation of the affordable care act. JAMA Netw Open. 2020;3(7):e2011981. doi:10.1001/jamanetworkopen.2020.11981
