"If you were to look at the [physician pay] environment 10 years ago, going into medical school, primary care was not something you were encouraged to do, certainly for economic reasons," Otto says. "The money was in specialties. At that point CMS started to [ramp] up reimbursement to encourage primary care. I think that's been reflected in the pay levels over the past several years.
"But there's still a big delta gap between what primary care is paid and specialists. Will that gap ever close? I'd be surprised if it did," Otto says. "Specialists will continue to be paid more than primary care, but I think with the emphasis on primary care in the context of all going on in healthcare, you may be starting to see pay increases overall, perhaps at a rate higher and faster than we've been seeing."
Incentive plan designs have been "typically married to production, meaning, 'I'll pay you a base salary if you are hitting the production number,'" Otto explains. But measurement of quality outcomes and patient satisfaction is on the rise, he says.
"What I'm seeing is employers, hospitals, and healthcare systems using their incentive plans for physicians in a way that gets to process results or outcomes that are supporting what they are trying to do throughout their systems," Otto says. "The incentive plan designs are really to encourage behaviors that are consistent [with] not only what they expect of a physician practice but how it fits within a system."