Physician compensation increased in 2018, while changes in work relative value unit, or wRVU, productivity remained low, according to data from the American Medical Group Association's 2019 Medical Group Compensation and Productivity Survey.
The survey, conducted by AMGA's subsidiary, AMGA Consulting, found that overall physician compensation increased by a median of 2.92%, compared to a 0.89% increase the previous year. Productivity increased by 0.29%, compared to a 1.63% decline in 2017. Compensation per wRVU ratio increased of 3.64%, compared to a 3.09% increase the previous year.
WHAT'S THE IMPACT
Physician compensation rebounded from a stagnant 2017, but the increase in productivity in 2018 was not enough to make up for the decline from the year before -- meaning productivity hasn't risen since 2016.
In 2018, median compensation for all primary care specialties increased by 4.91%, up significantly from 0.76% in 2017. While compensation increased more than it had over the past several years, productivity was flat, with wRVUs increasing by only 0.21% in 2018. As a result, the median compensation per wRVU ratio increased 3.57%, the largest increase for primary care specialties in four years.
Medical specialties saw an increase of 1.9% in median wRVU production over last year's survey. The compensation per wRVU ratio increased by 2.65%, and the overall median compensation was up for medical specialties by 3.39%. A sample of medical specialties with more remarkable changes to the compensation per work RVU ratio are cardiology, dermatology, gastroenterology, hospitalist–internal medicine and psychiatry.
Care model changes are also leading nurse practitioners and physician's assistants to more frequently work with their own panel of patients, the survey showed.
THE LARGER TREND
There's been downward pressure on reimbursement, and as providers look for performance gains across the enterprise, compensation leaps out. It's the biggest line-item expense for providers, representing 50 to 70 percent of operating costs.
If physician compensation were to increase, it would be an indication that an organization is focused more on clinical quality than on volume, which is what will ultimately be beneficial for providers, given that the move to value-based care emphasizes quality over quantity.
ON THE RECORD
"As healthcare organizations move from volume-based to value-based payment models, we've observed increased scrutiny on primary care performance," said Elizabeth Siemsen, AMGA Consulting director. "Medical groups continue to focus on delivering care in the most appropriate setting with the greatest efficiency -- and often place primary care providers at the center of this strategy. Concurrently, in recent years, the AMGA survey has shown a slow uptick in the proportion of primary care physicians reported at less than a 1.0 clinical FTE, indicating an increase in part-time providers. In order to recruit and retain the primary care workforce, it may be that the market demanded a compensation course correction this past year."