The Division of Economic and Health Policy Research conducts independent research to support AMA federal, state and private sector advocacy agendas.
One of the division’s most significant efforts is the Physician Practice Benchmark Survey, which focuses on the practice arrangements and payment methodologies of physicians who take care of patients for at least 20 hours per week and don't work for the federal government.
The Benchmark Surveys have been conducted in every even year between 2012 and 2018. Policy Research Perspective reports, based on the surveys, provide detailed analysis of the data.
2012-2018 Data on Physician Compensation Methods: Upswing in Compensation through the Combination of Salary and Bonus
This report (PDF) provides a detailed examination of how physicians were compensated by their practices between 2012 and 2018. The data show that the percentage of physicians paid by a combination of two or more methods increased from 48.2 percent in 2012 to 57.3 percent in 2018 due to the increase in the percentage of physicians who received more than half their compensation from salary combined with at least one other method; increasingly, salary was used in combination with bonus. Although salary remained the primary method used to compensate physicians, personal productivity was still an important factor in physician compensation, especially among practice owners.
Payment and Delivery in 2018: Participation in Medical Homes and Accountable Care Organizations on the Rise While Fee-for-Service Revenue Remains Stable
This report provides a detailed look at the extent to which physicians are in practices that participate in care delivery models (medical homes and accountable care organizations) and are involved in various payment methods (fee-for-service, pay-for-performance, shared savings, bundled payments, capitation).
53.8% of physicians reported participation in at least one type of accountable care organization (Medicare, Medicaid, or commercial) in 2018, up from 44% in 2016. Participation in medical homes was 31.9% in 2018, up from 25.7% in 2016.
The data on payment methods show that 63.1% of physicians were in practices that received payment from at least one alternative payment method (pay-for-performance, shared savings, bundled payments, and capitation). However, the data also show that alternative payment methods have not replaced fee-for-service in the practice revenue stream. In 2018, an average of 70.3% of practice revenue came from fee-for-service and 29.7% from alternative payment methods; similar findings were present in 2012, 2014, and 2016.
Updated Data on Physician Practice Arrangements: For the First Time, Fewer Physicians are Owners Than Employees
This report offers four viewpoints on physician practice arrangements:
- Whether physicians are owners, employees or independent contractors with their main practice
- The practice type in which they work (e.g., single or multi-specialty group)
- How many physicians are in their main practice
- The ownership structure of their main practice
This study shows that in 2018 a new milestone has been reached - 2018 marked the first year in which there were fewer physician owners (45.9%) than employees (47.4%). The report also shows that while the distribution of physicians has been shifting toward large practices and practices that are hospital-owned, in 2018 40% of physicians still worked in practices that were both small (10 or fewer physicians) and physician-owned.
Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50%
This study shows that for the first time in 2016, less than 50% of physicians (47.1%) had an ownership stake in their practice. It also highlights that despite the continued trend toward larger-sized practices, the majority of physicians still work in small practices. In 2016, 57.8% of physicians worked in practices with 10 or fewer physicians.
How Are Physicians Paid? A Detailed Look at the Methods Used to Compensate Physicians in Different Practice Types and Specialties
This report provides a detailed examination of how physicians are compensated by their practices. We find that while salary continues to be the dominant method of physician compensation, productivity is also a large and important factor, especially for physicians who are practice owners. In 2016, the average share of compensation from salary was 52.5% and the average share of compensation from productivity was 31.8%. We also find evidence that the use of multiple methods to determine physicians’ overall compensation has been on the upswing. In 2012, 48.2% of physicians indicated that their compensation was dependent on more than one method compared to 51% in 2014 and 54.4% in 2016.
Medical Liability Claim Frequency Among U.S. Physicians
This paper presents estimates of claim frequency among U.S. physicians and explores whether the likelihood of claims varies by age, gender, specialty and practice arrangement. It finds that in 2016, 34% of physicians had a claim filed against them during their careers and that claim frequency varies by certain factors, particularly age, specialty and gender.
Payment and Delivery in 2016: The Prevalence of Medical Homes, Accountable Care Organizations, and Payment Methods Reported by Physicians
This report provides a look at the extent to which physicians are in practices that (1) participate in medical homes and Accountable Care Organizations (Medicare, Medicaid or commercial) and (2) receive fee-for-service (FFS) and alternative payment models (pay-for-performance, capitation, bundled payments, or shared savings).
In 2016, 59.1% of physicians were in practices that received payment from at least one APM. Nonetheless, FFS remained a dominant source of practice revenue with an average of 70.8% of practice revenue coming from this method, similar to what was observed in 2012 and 2014.
In 2016, we also found that 25.7% of physicians were in a practice that belonged to a medical home and, across the three ACO types, participation rates ranged from 20.9% for Medicaid ACOs to around 32% for Medicare and commercial ACOs.
However, we found that it was not unusual for physicians to be uncertain about practice participation. For medical homes and Medicare ACOs, roughly 1/4 of physicians indicated that they did not know if their practice belonged to that model.
Physicians’ Patient Mix–A Snapshot from the 2016 Benchmark Survey and Changes Associated with the ACA
This report provides a current look at whether, and to what extent, physicians treat patients with different types of insurance or who were uninsured. Results from the 2016 Benchmark Survey show that nearly all physicians had privately insured patients (98.0%) and most saw Medicare patients (89.3%), but most also had Medicaid (82.6%) and uninsured patients (75.6%).
The results for 2016 were then compared to those from the 2012 Benchmark Survey to see how physicians’ patient mix changed since the Affordable Care Act (ACA) went into effect. The results indicate that, as a percentage of their patients, physicians saw more Medicaid and privately insured patients in 2016 compared to 2012, and the average uninsured patient share went down. However, the changes for Medicaid and uninsured patients were only evident in states that chose to expand their Medicaid programs under the ACA.