enrollment and other information can be found at
https://pcip.gov. Information about PCIP, as well as help for patients needing assistance ap- plying for the plan can be obtained by calling CHAP at (855) TEX-CHAP or (855) 839-2427 or by visiting www.Tex
asHealthOptions.com.
Physician income remains flat
Physician income remained relatively flat from 2009 to 2010, according to a study released in July by The Medicus Firm, a Texas-based national physician- recruiting firm. According to the study, average physi- cian income actually fell by 0.14 percent from 2009 to 2010. Thirty percent of physicians attributed the lack of income growth primarily to decreasing reim- bursements. Physicians reporting income declines
in 2010 included radiologists and on- cologists. On the other hand, emergency medicine physicians reported their in- come rose 5.5 percent on average, and psychiatrists reported their income rose 11.5 percent on average. “While many physicians don’t choose medicine for the money initially, they do want to be compensated fairly, espe- cially considering the additional years of school and training invested,” said Jim Stone, Medicus president and manag- ing partner. “Physicians may be more susceptible to career burnout or dissat- isfaction if they do not feel they are paid what the market bears for their services.” The Medicus Firm surveyed more than 2,300 U.S. physicians across 19 medical specialties. A small percentage of the respondents included nurse prac- titioners, physician assistants, and physi- cians in training. While the survey did not break out specific income data by state, 50 percent of Texas physicians responding to the survey said their income had remained approximately the same. That compared
42 TEXAS MEDICINE October 2011
to 45.3 percent of physicians nationally who said their income was approximate- ly the same. Thirty-two percent of Texas physi- cians said their income had increased either somewhat or significantly, while 17.2 percent said their income had de- creased somewhat or significantly. Asked what was limiting their income the most, 21.7 percent of Texas physi- cians blame reimbursement decreases. That compares to 30.2 percent of physi- cians nationally who gave that answer. More than 17 percent of Texas physi- cians blamed overhead increases, com- pared to just 9.4 percent of the national sample. Two hundred fifteen Texas physicians
participated in the survey, making up 9.2 percent of respondents.
• Hospital, physician, post-acute pro- vider, and other Medicare-covered services provided during the inpatient stay, as well as during recovery after discharge to the home or another care setting (Model 2); or
• Hospital, physician, post-acute pro- vider, and other Medicare-covered services beginning with the initiation of post-acute care services after dis- charge from an acute inpatient stay (Model 3).
In Models 2 and 3, components of the bundle may include clinical laboratory services and durable medical equipment. Under Model 4, CMS would make a
CMS launches bundled payment projects
The U.S. Centers for Medicare & Med- icaid Services (CMS) has invited physi- cians and other health care professionals to apply to help test and develop four different models for bundling payment. CMS is seeking applications for four
broadly defined models of care involv- ing a retrospective bundled payment ar- rangement, while the fourth would pay providers prospectively.
In these models, CMS and physicians would set a target payment amount for a defined episode of care. Participants would be paid for their services under the original Medicare fee-for-service system, but at a negotiated discount. Af- ter treatment ends, the total payments would be compared with the target price. Participating providers would share in any savings. Providers have the flexibility to choose whether to define an episode of care as:
• Hospital services during an acute inpatient stay, where physicians are partners in improving care (Model 1);
single prospectively determined bundled payment to the hospital that would en- compass all services furnished during the inpatient stay by the hospital, physi- cians, and other practitioners. Physicians and other practitioners would submit “no-pay” claims to Medicare and would be paid by the hospital out of the bun- dled payment.
The deadline to submit letters of in- tent for Model 1 expired on Sept. 22, but physicians have until Nov. 4 to submit letters of intent to participate in the oth- er three models.
Additional information about the initiative can be found online at www
.healthcare.gov/news/factsheets/bun dling08232011a.html. CMS says both Medicare and private physicians have shown that bundling payments improves care for patients and leads to better health, better care, and lower costs. Among programs CMS cited as reducing costs was a three-year Medicare cataract surgery demonstra- tion project started in 1993 that re- duced spending by $500,000 for 7,000 procedures at sites in Dallas-Fort Worth, Cleveland, and Phoenix. n
Ken Ortolon is the senior editor of Texas Medicine. You can reach him by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
ken.ortolon@texmed.org.
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