"We're moving into a world, at least in theory, where [physicians are told] 'I'm not going to pay you because you are just doing things,' but practices and systems want to do the right things and hit quality outcomes," Otto adds. "Over the next five years, I can see us moving from fee-for-service to global capitation or some other structure and pay for quality, and not pay for something like three MRIs."
Still, "we aren't all there yet," Otto says.
That's reflected in the Hay Group report on salaries, which states: "Among physician group practices and hospital-based facilities, the majority of physicians' pay increases are determined individually, based on productivity and performance."
Overall, however, incentive payouts are beginning to reflect the move toward quality and patient satisfaction, Otto says.
In the Hay Group report, 71% of pediatric practices reported incentive payouts in 2013, and 54% of primary care physicians. Other specialties were at 50% at minimum.
Of the incentive payouts, most involved bonuses or recruiting incentives (28%); administrative differentials (23%); and on-call differentials, relocation packages, or tuition reimbursement (each 16%). Administrative differentials refer to the rate of pay to doctors for interim administrative responsibilities beyond the scope of their normal positions. On-call differentials refer to pay for doctors on a standby status.