There are fewer annual incentive programs being offered to physicians, according to a new report from the Hay Group, a global consulting company. In the most recent report, “2011 Physician Compensation Survey,” the group says that these programs decreased slightly from their highest reported usage of 69 percent in 2010 to 64 percent in 2011. Twenty-three percent of respondents reported that they do not have annual incentive programs, nor do they plan to implement them in the future.

Annual incentive programs to dip slightly (% that have programs)

“The decline this year is surprising,” says Jim Otto, senior principal in the Hay Group’s health care practice. “When you look at the six-year trend, you can see the usage increasing, with a slight dip in 2011. We’ll keep a close eye to see what is reported in 2012. Incentive plans, or at-risk pay, is a great tool to help shape behaviors. It’s a way for owners of an organization to get physicians to focus on key metrics and provide a reward at the same time.”

These programs provide incentive pay based on short-range performance — typically a year or less. Annual incentive programs may consist of short-term incentives and may include a component tied to long-term incentives. These incentives may be based on stock, cash, or both.

Annual pay to rise 2.5% next year

Overall, physicians in all types of organizations can expect smaller salary increases in 2012 than this year; salary increase budgets will drop to 2.5 percent from 2.7 percent in 2011. According to the report, however, the physicians who work in group practices will fare better than their hospital-based counterparts.

The report says that all physicians who are group-based can expect to see salary increases of 3.2 percent in 2012. Looking at specialists only, those who are group-based will see a 4.5 percent salary increase in 2012.

Comparing these numbers with hospital-based physicians shows that all physicians who are hospital-based will see a salary increase of 2.5 percent, from 2011 to 2012. Specialists who are hospital-based exclusively will see a salary increase of 2.4 percent during the same period. The group surveyed 144 physician specialties, including 35 pediatric specialties, 30 non-physician provider positions, and 19 medical directors. The report also says that the largest median base salary increase movement for 2010 and 2011 were for the following staff physician positions: oncologists (13 percent change); dermatologists (9.9 percent change); pediatric neurologists (9.1 percent change); pediatric intensive/critical care physician (8.8 percent change); and oncologic gynecologists (7.7 percent change).

On the other end of the salary spectrum are physicians who will see the largest decrease in median base salary for 2010 and 2011. These physicians were: hematologists (−5.4 percent); nuclear medicine physicians (−6.4 percent); pediatric hematologists (−10.1 percent); anesthesiologists who were medical directors (−10.1 percent); and family practice physicians who were medical directors (−11.3 percent).

When determining base pay structure, 50 percent of organizations set physician pay on an individual basis, 28 percent establish formal salary ranges, 18 percent use market rates, and 1 percent use step-rate progression. According to the 2011 report, measures for determining payouts are dominated by quality and patient satisfaction.

Source: Hay Group, 2011 Physician Compensation Executive Summary

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.