Partners ties physician pay to patient load, complexity

Mass General, Brigham and Women's PCPs could boost their salaries

Partners HealthCare this year is tying about 10% of physician salaries to practice size and patient complexity in an effort to increase access to care and prepare for quality-based payments.

Under the incentive model, the 360 employed primary care physicians (PCPs) at Massachusetts General Hospital (MGH) and Brigham and Women's Hospital could increase their salary—which stands at about $200,000 per year for full-time PCPs—by seeing more patients than average or by accepting patients with multiple medical problems. Meanwhile, a physician's pay could fall if they provide care for fewer patients than average.

Potential benefits
According to the Boston Globe, the initiative—which began last year by tying 2% of payments to practice size and patient complexity—already has improved primary care access, after dozens of PCPs at the hospitals started adding one to two new patients each week.

Hospitals have "a social obligation to provide access to care," says Partners' Timothy Ferris, who notes that the initiative will prepare Harvard-affiliated hospitals and physicians for payment changes brought by the federal health reform law and other cost-control, care-quality efforts.

Hospital officials also expect the plan to reduce costs and help Partners employees obtain PCP appointments through the system's new insurance plan, which provides financial incentives for receiving care from within the Partners network.

Physician, expert reaction
Physicians were "pretty mixed" about the salary change, said MGH physician Katherine Sakmar, adding that many were scared they were going to face payment reductions. However, she noted that the system credits physicians who manage complex patient populations. Before, "everyone wanted to have the 30-year-old healthy lawyer…and [n]o one wanted to see the retired 70-year-old with multiple problems and diabetes."

According to Harvard University health economics professor David Cutler, the salary model is a boon for patients, as long as hospitals support physicians by providing additional staff. To handle higher primary care volumes, the Globe reports that MGH and Brigham and Women's are hiring additional nurse practitioners and physician's assistants, who will work with PCPs to develop a team approach to primary care (Kowalczyk, Globe, 3/6).


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