PCP compensation increased after ACA
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The Affordable Care Act did not lower primary care physician or specialist compensation as previously feared, according to research published in JAMA Network Open.
“When the Affordable Care Act (ACA) was passed, physicians were unsure how their salaries would be affected,” Walter R. Hsiang, BS, of the Yale School of Medicine, and colleagues wrote.
Hsiang and colleagues said a variety of factors may have affected physician compensation, including a push towards alternative payment methods and lower insurance payments from health exchanges. In addition, the ACA included two temporary fee increases for PCPs — the “Medicaid fee bump” in 2013-2014, and the Primary Care Incentive Program from 2011 to 2015.
Researchers evaluated compensation trends among PCPs and specialists from 2008 to 2017 using the Medical Group Management Association’s voluntary physician compensation survey. The survey included 20,000 physicians in private practices, academic departments, hospitals and other related organizations in the United States.
They noted that while the survey is the largest known nationally representative sample of its kind, physicians included were not random and tended to overrepresent large medical groups.
Hsiang and colleagues found that compensation for specialists increased from $378,600 in 2008 to $399,300 in 2017, with a weighted mean increase of 0.6% each year.
PCP compensation experienced a greater increase after ACA — from $214,100 in 2008 to $247,300 in 2017 — with a weighted mean increase of 1.6% each year.
From 2008 to 2017, specialist premiums decreased from $164,500 to $152,000, or from 77% to 61%.
Hsiang and colleagues said while compensation for both specialists and PCPs increased after the implementation of ACA, “the gap between specialty and primary care salaries remains sizeable.”
Therefore, they wrote that in the face of another potential health care reform, “policymakers should recognize that physician compensation will remain a significant concern and that differences in compensation between PCPs and specialists will matter.”