Most references to the elephant in the room usually say that no one is talking about it. That’s not the case with how the roles of primary care physicians and specialists will change in an industry that, thanks to health reform, might be dominated by accountable care organizations. Of course, not everyone agrees that ACOs will be the primary organizations — some say ACOs can’t work (http://bit.ly/JreCMX).
“It is too early to tell what effect ACOs will have on physicians’ income,” says Glen Stream, MD, president of the American Academy of Family Physicians. “That will likely vary among specialties. ACOs will need a solid foundation of primary care to be successful, but it is not clear that ACOs will include compensation formulas that reward the work of primary care physicians that makes them successful.”
On the other side, Tom Flannery, PhD, a partner in Mercer’s “human capital” business and a senior compensation consultant, thinks that ACOs will be a bulwark of health care no matter what the fate of the Affordable Care Act.
“Employers and employees are really tired of the cost of health care,” says Flannery. “If Washington doesn’t do something, then the industry is going to have to do something, or the employers are going to have to do something.”
Doctors surveyed in Medscape’s “Physician Compensation Report 2012” for the most part don’t know how ACOs might affect their income, and those who have an opinion are about evenly split as to whether their pay will rise or fall.
ACOs are expected to shift more power to primary care doctors, and it seems to be happening right now. “Pediatrics has historically been a low-paid specialty,” says Flannery, “but we’re beginning to see a shift in pediatrics, family medicine, internal medicine. It’s a recognition that the income levels need to go up to attract more people into primary care.”
Stream is cautious about drawing conclusions from the Medscape data. “Physician payment is complex and includes multiple variables that make it difficult to assign specific causal factors in these income changes,” he says.