Don’t look now but nurse anesthetist pay is comparable to primary care physicians, despite differences in years of education between the two professions.

Certified registered nurse anesthetists (CRNAs) are making an average salary of $189,000 year, according to the most recent Review of Physician and CRNA Recruiting Incentives, issued by Merritt Hawkins & Associates. Compare that to the average salary offer made to: family physicians ($173,000), internists ($186,000), and pediatricians ($171,000), according to the report.

Primary care doctors must complete four years of college, four years of medical school and three years of residency for a total of 11 years. CRNAs must complete a four-year nursing program, then complete a two to three year master’s program in anesthesiology for a total of six to seven years.

Phil Miller of Merritt Hawkins says, “The salary offers in our survey generally are somewhat below the average income of physicians as shown in surveys such as the one compiled by the Medical Group Management Association. Our numbers indicate what you have to offer to persuade a physician to come to a practice. Based on their level of effort, they often can make more.”

That’s not to say there is no demand for primary care doctors, however. Compared to 2005–2006 salaries, this year’s crop of family physicians, internists, and pediatricians saw an increase in salary of 19 percent, 15 percent, and 13 percent, respectively. Specialists who made the most gains in salary were hospitalists, orthopedic surgeons, neurologists, and cardiologists.

Signing bonuses from hospitals, medical groups, and other organizations, have also become the norm, according to the report. They’ve been on a steady increase over the past 10 years. Signing bonuses were offered in 85 percent of the recruitment searches conducted by the company, with bonuses in 2008–2009 averaging $24,850, up from $20,000 in 2006–2007, and $14,030 in 2004–2005.

Physician searches that included a signing bonus

Source for both: Merritt Hawkins & Associates. 2009 Review of Physician and CRNA Recruiting Incentives

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.