same time frame (an average of 1.8% per year), which
means that compensation today claims a much larger
part of the net collected dollar than in 2009.
With MACRA moderating inflationary increases in
the Physician Fee Schedule, how much longer can this
level of compensation growth relative to collections be
sustained? We suspect that groups will soon conclude
that a standard annual 3.0% increase for all providers is
cost-prohibitive. Given value-based reimbursement programs’ heavy emphasis on metrics and initiatives that are
driven by primary care, material amounts of incentives
earned in these alternative payment programs will likely
be shifted toward primary care versus specialists. Primary care pay already seems to be increasing at a slightly
faster pace than it is for specialists (see below).
Overall changes in compensation, wRVUs, and net
collections for common specialties appear in Table 1.
Next, we examine some selected specialties in more detail.
Given the large increases in median compensation
Primary Care Specialties
in general cardiology over the last few years, as shown
in Figure 3, we expected that the market would steady
soon. This year, median compensation increased by
0.5%, much smaller than the 5%-7% increases we saw
over the last two years. While median wRVU produc-
tivity and median compensation per wRVU increased
only marginally ( 1.4% and 0.8%, respectively), median
collections increased 4.9% this year, and compensation
to net collections saw a significant decrease of 5.4%.
This year, using a weighted average of the medians
for the three major primary care specialties (Family
Medicine, Internal Medicine, and Pediatrics and
Adolescent), median compensation increased by 3.3%,
slightly outpacing physician increases overall (see
Figure 4). In addition, median wRVUs increased by
1.5% and net collections increased by 1.6%. Compensation per wRVU increased 1.7%.
These results cause the authors of this article to
suggest that primary care physicians might already
be garnering some of the benefits of value-based
reimbursement. While risk-based payment programs
generally purport to apply to all providers who care