Adjusted for inflation, physicians' net income from the practice of medicine declined 7 percent between 1995 and 2003, according to a national study reported by the Center for Studying Health System Change. Primary care physicians and general surgeons fared the worst in keeping pace with inflation; specialty occupations did much better.

The study cites flat or declining fees from both public and private payers as the major contributor to this decline. Medicare payment rate increases for physician services amounted to 13 percent, but general inflation was 21 percent over those eight years. In 1995, commercial fees were 1.43 times Medicare fees; by 2003 this ratio had fallen to 1:23. Declining fees affect all physicians but for medical specialists, whose productivity and volume of procedures are growing rapidly, this has less effect.

For primary care physicians and specialists dependent on office visits rather than procedures, declining fees are likely to mean declining income.

Despite the downward trend, medicine overall remains one of the most well-paid professions. Median income for patient-care physicians was $170,000 in 2003, and mean physician net income was about $203,000. The Bureau of Labor Statistics reports mean annual wages of $36,201 for all occupations in 2003.

Source: Losing Ground: Physician Income, 1995–2003. Center for Studying Health System Change

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.