OF THE 30 specialties surveyed for the 2012 American Medical Group Association (AMGA) 25th Annual Medical Group Compensation and Financial Survey, nearly 3 in 4 saw increases in compensation, averaging 2.8 percent above the previous year. But while radiologists remain some of the best compensated specialists, diagnostic and interventional radiology were among the five specialties that experienced a slight decrease in compensation from 2010 to 2011.
AMGA mailed the survey questionnaire to medical groups across the country in January 2012 and received responses from 225 groups representing more than 55,000 providers.
The survey showed that the median compensation level for interventional radiologists was $485,277, a 1.39 percent decrease from 2010 to 2011, while median compensation for diagnostic radiologists fell by 0.45 percent to $459,186. In terms of compensation, radiologists ranked fourth and fifth respectively among specialties surveyed.
Among other factors, experts say radiology may have reached a cooling off point after years of being considered a “hot” specialty.
“Whenever you see a big increase in a hot specialty like radiology, you will eventually hit periods that are a bit flatter,” said Brad Vaudrey, M.B.A., C.P.A., principal at Sullivan, Cotter & Associates, Inc., which administered the AMGA survey. “Now, a plateau is occurring.”
A number of factors are affecting the lower than average increases or “leveling out” of compensation in radiology, according to Donald W. Fisher, Ph.D., CAE, president and chief executive officer of AMGA. “Some of the primary drivers are shifts in the reimbursement levels from payers, new payment models that focus on value-based care (population health) rather than fee-for-service, and widespread integration of smaller, single-specialty practices into larger health systems,” he said.
The 2.8 percent overall weighted average increase in compensation across all specialties was also slightly lower than in recent years, Vaudrey said.
“The 2.8 percent increase is just below what we typically see, which is around 3 percent, so compensation growth has slowed down a touch,” Vaudrey said. “The biggest drivers were the primary care specialties, which isn’t a surprise considering the focus of healthcare reform on the primary area.”
Cardiac/thoracic surgeons remain the best-compensated specialty with a median compensation of $544,087, which was a 2.16 percent increase from the previous year. Following them are cath lab cardiologists with a median of $524,731, a 4.09 percent increase, and orthopedic surgeons with a median of $515,759, a 2.78 percent increase from the year before.
Specialties that recorded the biggest increases in annual compensation were hematology and medical oncology (up 7.13 percent to a median $348,157), hypertension and nephrology (up 6.99 percent to a median $277,934), and urgent care (up 5.17 percent to a median $242,145).
Endocrinologists experienced the biggest drop in compensation, from a median $233,000 to $221,400, a 4.98 percent decrease. In addition to radiology, other specialties experiencing decreases in compensation were rheumatologists (down 1.09 percent to a median $229,051) and otolaryngologists (down 0.81 percent to a median $374,384).
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The overall weighted average relative value units (RVUs) decreased for all specialties by 0.5 percent in 2011. RVUs are a measure of physician output based on the value assigned to each Current Procedural Terminology (CPT) code through the resource-based relative value scale used partially by Medicare and nearly all health maintenance organizations.
Because reimbursement by the Centers for Medicare & Medicaid Services (CMS) is based on the RVU system, overall revenue falls when RVUs decrease, according to experts. CMS rates per RVU may also be scaled downward or revised annually through the budget reconciliation process.
The survey showed that RVU rates for primary care and medical specialties were fairly flat, with increases of 1.4 percent and 0.2 percent respectively. RVU rates for surgical specialties increased by 1.2 percent. Interventional radiology had the third highest work RVU increase at 2.84 percent, behind infectious disease (4.37 percent) and urgent care (3.88 percent). RVUs for diagnostic radiologists decreased by 10.52 percent, the largest drop of any specialty.
“The growth of therapeutic procedures performed by interventional radiologists in oncology and gynecology may explain the increase in RVUs for interventional radiologists,” said David Yousem, M.D., M.B.A., a professor in the Department of Radiology, vice-chair of program development and director of neuroradiology at Johns Hopkins Hospital in Baltimore, and a nationally recognized expert on radiology economics.
Factors that may have contributed to the drop in RVUs for diagnostic radiologists include the declining number of CT procedures, due in part to public and industry-wide emphasis on radiation safety, and the impact of the poor economy leading to fewer elective procedures performed, Dr. Yousem said.
“Confusion about mammography recommendations and the impact of the multiple procedure 50 percent reduction for image interpretation made by CMS in its reimbursement calculations in 2011 may also have led to the decrease in RVUs,” Dr. Yousem said. CMS decreased the multiple procedure payment reduction for interpretation of imaging from 50 to 25 percent in 2012.
Vaudrey said that 2013 should show an overall increase in compensation of about 3 percent but he doesn’t expect to see a dramatic increase in compensation levels for radiologists any time soon.
“I think we’ll continue to see flat numbers,” he said. “I don’t think there will be more negative numbers—we don’t usually see negative numbers two years in a row—but I do think any increase will be below average.”
More information about the American Medical Group Association is available at www.amga.org.
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