How Are Doctors Paid? Learn the Incentives in Physician Compensation

[@georgie9854]

Wow so true a lot of hospitals do a revolving door which leads lots of patients being under-treated for care.

[@ahealthcarez]

Thank you for watching and for your comment!

[@stinksterrekerinski4450]

Thanks for posting new studies on the financial side of medicine.

[@ahealthcarez]

Thank you for watching and for your comment!!

[@garrywelch4041]

Thanks... Keep doing these great educational videos - You are a fearless disruptor that must be ethically grounded to do this great work and risk taking flack from other doc leaders.. I agree that patients and families must come first to have an ethical and long term, sustainable US healthcare system based on free market principles. I think the old guard in medicine are underestimating the standards of young docs coming into the system who will eventually know it is corrupted by money but that money is not satisfying personally after basic needs are met. Docs need inspiration, a societal mission, and an outlet for their passion and creativity, not just a sweet gig generating more money as a specialist? Primary care is a noble MD career and is where patients and families primarily go for help and protection from sickness. It is sad that we now know that next generation MDs don't follow their MD parents into primary care but pick "ROADS'for the money and higher status. THANKS

[@ahealthcarez]

Thank you for your thoughtful comment. Appreciate you watching.

[@MrPurveshc]

@@ahealthcarez hi you making some really good learning content, can you please create a video on clinical registries and it's overall impact

[@RaminR]

Another great video Eric - one of your better ones if there is such a thing because you clearly define the problem - and define the solution is to be independent

[@ahealthcarez]

Thank you for watching and for your encouragement.

[@drshanep]

Find an independent doc near you and hold on to them tight.

[@fischerclinic2816]

I do!

[@ahealthcarez]

#True

[@Nanomachines5on]

Unfortunately a dying breed. They are legislated and competed out of existence by absolutely massive organizations.

[@Sweetmuscatwine]

This is great information. Ty Doctor

[@railzip]

Thank you! Its like fighting an uphill battle

[@ahealthcarez]

#True. Thank you for watching and for your comment.

[@samk.970]

I have been thinking this for long. Volume should not be the only determinate of provider's comp. Do not quote me on this, but Kaiser may be a good example for how to not relay on RVUs, according to one of its providers. Need to research this more.

[@ahealthcarez]

Thank you for watching and for your comment, Sam.

[@peterrao1]

We need to go back to more independent practices and physicians having autonomy. Value-Based payments and purchasing in general have major flaws and the insurance carriers have continued to benefit from VBP programs. Hospitals and Physicians continue to work hard on improving outcomes, but the cost of practice overhead has only increased. A major piece of this expense is staff and physician recruitment.

[@ahealthcarez]

Thank you for watching and sharing your perspective.

[@younsibeso]

I really love the videos you put out. Please keep them coming. Would love to learn more about value based care, the different models. What MSOs do etc

[@ahealthcarez]

Super! Thank you for watching!!

[@bikeman9899]

The golden rule is at play here. He who has the gold, makes the rules. It's no surprise then, that docs are paid , mostly, to boost volume. That's fine, as insurance is a for profit business, and "dems da rules". I have a few questions for the speaker here. 1) who is the real customer of the doctor? Is it the insurance company or the patient? 2) what other incentives ( financial) do insurance payers use to reward docs and their practices to keep patients in the revenue pipeline? Are there specific metrics captured on patients which measure chronic conditions and which could be used to predict life span? Are there metrics which should be captured, but are not, which would, jf measured, improve patient outcomes? A parallel for consideration. Collision repair for crash damaged cars and PCP practices have a lot in common . Both depend almost completely on insurers for revenue, i.e sales. The first question asked of any customer by either of these businesses is, "who is your insurance company?". Both industries depend kn the insurer not only for payment, but for deal flow as well. "Who js your actual customer?" is a constant subject kf debate in the auto collision industry. I think it's high time for physicians tk ask themselves the same question. A candid answer will pose discomfort for any physician who takes his/her hippocratic oath seriously.

[@wednesdayschild3627]

A major hospital in my area charges more for every test. The hospital is in financial trouble. I think they are doing more and charging more for profits, even though they are non profits. The specialists work at that hospital.

[@ahealthcarez]

Thank you for sharing your experience.

[@antoniotiberi1569]

That’s why my PCP is in private practice.

[@AggresivelyBenign]

As far as I know, all profee charges are still FFS. So if a provider is contracted to a hospital, even if they are independent, it doesn’t seem like it will have an effect on reimbursement for profee.

[@ahealthcarez]

Thank you for your point of view. Appreciate you watching.

[@ismaileee]

What would be the effect of a reimbursement based on prepaid capitation (much like DPC practices) on quality outcomes?

[@ahealthcarez]

Great question. Both ChenMed and Intermountain have seen increased primary care quality outcomes with capitation.

[@houstonbaboon8992]

Why is it hard to convince hospitals to adopt VBC? Is it the mindset or the administration effort? Financially VBC should make sense for them, benefit more than fee based? Why they don’t see it that way if that’s the case. Thank you. If you answered already in previous videos, apologize.

[@ahealthcarez]

VBC entails taking on risk… hospitals generally do not want to do that. Fee-for-service does Not involve taking on risk and is what they are used to.

[@houstonbaboon8992]

@@ahealthcarez thank you you the best

[@Vivek-fc7rq]

Impressive insights.

[@ahealthcarez]

Thank you for watching and for your comment.

[@whiteowl8594]

Amazing Video. Do you have a video around risk adjustment? And how it works?

[@ahealthcarez]

No. Great suggestion.

[@georgie9854]

I want to startup a medicare advantage plan in Alaska since it does not exist in that area what would you advise me as the first step?

[@ahealthcarez]

Contact Sachin Jain from SCAN Health Plan in California. He knows much more than I do.

[@SamianHQuazi]

Would you do a video on travel nursing? I'm a travel nurse and we're all over the news for what Congress is trying to do in cap our pay (indirectly, of course... going after our agencies for "price gouging"... but let's get real, the healthcare execs and their lobbyists are really targeting our high wages)

[@ahealthcarez]

Good suggestion. Thank you.

[@gerardhoeltzel4690]

in your final point - you're suggesting that the juggernaut that is the large health care system imposes RVU based payment models on its providers? whereas independent physician practices are more free to innovate and experiment with new payment systems? am i understanding that correctly?

[@ahealthcarez]

More like priority of hospital-run primary care is to feed referrals to specialists. Priority of independent primary care can be the patient.

[@sanadbenali6993]

How is quality quantified in terms of doctor compensation

[@ahealthcarez]

Good question. Different metrics by specialty.

[@sanadbenali6993]

@@ahealthcarez I heard that a problem of quality based systems that use patient outcome as a metric is That doctors try to avoid difficult cases and risky cases Any research on this?

[@bdpatton2]

Do you subscribe to any of Clarivate solutions?

[@ahealthcarez]

I do not.

[@bdpatton2]

@@ahealthcarez but do subscribe to proforma and others?

[@sanadbenali6993]

Thank you

[@ahealthcarez]

You’re Welcome!

[@chrisholland5208]

Enjoy your videos. The reason physicians in hospital practices are compensated based on RVUs is that it is the most compliant way to justify compensation. You must justify fair market value for compensation. Most use MGMA compensation survey to evaluate compensation including base and incentive compensation for a specific geography to establish fmv. The value based model for payment with RVU compensation can be a problem in that the incentives for both parties are not aligned.

[@ahealthcarez]

Thank you for sharing your thoughts!

[@Nephromancer3]

What about the specialists? Their pay and reimbursement have been cut by half in the last two decades. Yea im sure I'll hear crickets on this one

[@ahealthcarez]

Depends on specialty. Ortho, cardiology income up from share of ASC profits (Ortho) and imaging/procedure facility profits (Cards). Thank you for watching.

[@Susieq26754]

I have had hormone issues that cause inflammation all over my body. I have to wait 6 months to see a endocrinologist. Just to get my T4 treated. But I will not get tested for T3. Many women are not getting tested for T3. We are suffering from low Thyroid and it can cause premature death. Do doctors secretly keep treatments that work from us? I have been on this roller-coaster for 11 years. Adhd meds did help me, but now their is a national shortage of them. Only one Thyroid medication for women. One size fits all. Or surgery to remove the whole Thyroid. Men get testosterone therapy and live full lives. But if you mention anything about it as a woman, you are ridiculed and shamed. Movie stars, sports figures have access to all these hormones and performance drugs. All the while, women are suffering from autoimmune Thyroid issues that have them bedridden.

[@thomasmazur6916]

I believe they're paid incentives for referrals

[@ahealthcarez]

Illegal per the Stark Law, but that does not stop it from happening.

[@reavealerofmysteries]

God save us

[@ahealthcarez]

Thank you for your comment.

[@watchespn1913]

Exposing the truth

[@ahealthcarez]

Thank you for your feedback.