Yesterday during the Aspen Spotlight Health Conference sessions, “Algorithms, Big Data, and Your Health” and “The Science Of Delivering Health Care” the big discussion was about the potential of “augmented intelligence” and “assistive technologies” to change the price point of health and human service delivery. What was interesting to me is that the presenters focused on “task shifting” as the primary way to harness technology in cost reduction-focusing on the idea that work done by specialists can be done by primary care professionals; that work done by primary care professionals can be done by other health workers; and that many services can be tech-enabled and directed by consumers themselves.
Toyin Ajayi, Chief Health Officer of Cityblock Health, spoke about task shifting as a key strategy to address inequities in access to health care—essentially augmenting and extending scarce clinical professionals’ time. She developed this perspective as part of the work of her organization in developing health systems for underserved urban populations. Lizzie Dorfman, Technical Program Manager with Google Brain gave a great example of task shifting—the work of her team at Google developing big data models to interpret diagnostic tests, reading scans, and reading biological laboratory samples. A diagnostic tool that will allow non-specialists to manage the diagnostic process. And not only can technology be a tool for creating the “tech-enabled professional”, Jay Komarneni, the founder of the Human Diagnosis Project, spoke of using technology for the competency testing that would allow clinical professionals to move “beyond their license” in delivering care with new technology.
This approach is not without its challenges. All the panelists spoke about the “resistance”—financial, cultural, regulatory, and more—to adopting clinical treatment technologies in the United States. Kelller Rinaudo, the Chief Executive Officer of Zipline, a company that delivers medical supplies of all types by drone, spoke about their growing business outside the United States—and their challenges getting scale in the U.S. market. But, I think that cost pressures in fee-for-service rates, and in the move to value-based reimbursement, may hasten the transition to tech-enabled professionals and consumers.
Our team has covered the changes in compensation in the positions that deliver the great volume of care to consumers with complex needs. What we see are steady increases in compensation at a time when service rates have remained flat.
Psychiatrists-The median compensation for psychiatrists rose more than any other specialty between 2017 and 2018, up 16% from $235,000 to $273,000. Foreign-trained psychiatrists earn slightly more at $308,000 vs. $256,000; as do men, at $285,000 vs. $250,000 (see Medscape Psychiatrist Compensation Report 2018).
Primary Care Physicians-Median compensation for primary care physicians in 2017 was $257,000, up 10.6% since 2013, when median compensation was $233,000. Within the primary care specialty, family medicine physician median compensation rose 12% between 2013 and 2017, but their median number of work relative value units (wRVUs) rose less than 1%. In two states, median compensation for primary care physicians declined: Alabama was down by 9%, and New York was down by 3%. It increased in five states: Wyoming (41%), Maryland (29%), Louisiana (27%), Missouri (24%) and Mississippi (21%) (see Primary Care Physician Median Compensation At $257,000 In 2017).
Physician Assistants-Over the last five years, the average certified physician assistant (PA) salary increased 12.7%, from approximately $95,500 in 2012, to $107,700 in 2017 (see Average Physician Assistant Salaries Increase 12.7% Since 2012 To $108,000). This price tag ranges from a high of $120,000 (pathology), to a low of $85,000 (adolescent medicine, gynecology, and pediatrics).
Nurse practitioners-From 2013 to 2017, median compensation for nurse practitioners rose by 7.9% (from $98,250, to $106,043), and the median compensation for non-physician clinical professionals rose by 8.4%, from $102,000 to $110,612 (see Primary Care Physician Median Compensation At $257,000 In 2017).
Social Workers-The median annual wage for all social workers was $47,980 in 2017; there are wide ranging differences in specialties including health care ($54,870); child, family, and school ($44,380); and mental health and substance abuse ($43,250). Differences in setting included hospitals ($58,490); local government ($52,900); ambulatory health care ($48,340); state government ($46,120); and individual and family services ($40,800) (see Occupational Outlook Handbook: Social Workers). The average salary for all social workers has risen 9.7% since 2010, when it was $43,700 (see How Much Do Social Workers Earn?).
Applied Behavior Analysts-Salaries for ABAs as a specialty are not as readily available, but the Sage Colleges report that ABA therapists with a Bachelor of Science in Applied Behavior Analysis earn an average of $47,281 annually. Entry-level salaries range from $25,528 to $50,862 annually, and staff with a Master of Science degree in ABA earn $55,402 on average, with the highest earners collecting $80,287 annually (see Salary Information for Applied Behavior Analysis Therapists).
Direct Support Staff-In 2017, the average annual wage for home health aides was $23,210, and $23,100 for personal care aides (see Occupational Outlook Handbook: Home Health Aides and Personal Care Aides); this is up about 16% for both positions, which made $20,000 in 2010 (see Home Health Aide Salary & Career Outlook and Better Pay Coming For Home Health Care Workers). The lowest 10% of health home aides earned less than $18,450, and the highest 10% earned more than $31,260. For personal care aides, the lowest 10% earned less than $18,160, and the highest 10% earned more than $30,750. And, in 2016, the average rate of direct support personnel (DSP) turnover was 45.5% (see Direct Support Personnel Turnover Rate For I/DD Sector Averaged 45.5%).
Peer Support Staff-Average peer specialist compensation was $15.42 in 2015. Compensation varied by type of employer, including Consumer/Peer Run Organization ($13.73), Community Behavioral Health Organization ($14.18), Health Care Provider Organization ($17.23), Psychiatric inpatient Facility ($15.85), and Health Plan/Managed Care Organization ($17.96) (see National Survey of Compensation Among Peer Support Specialists). And, Medicaid fee-for-service reimbursement rates for selective states found a wide variation in reimbursement for peer support: group rates for a 15-minute period ranged from less than $2.00, to over $5.00 and individual rates ranged from $6.50 to $24.36 per 15 minutes; comparatively, average peer specialist compensation was $15.42 in 2015 (see Does Peer Support Pay?).
In the end, it may be that the market forces that are opposed to redefinition of professional roles may fall to the market forces looking to expand access and reduce costs through the leverage of technology in service delivery. In the meantime, provider organization executive teams should look for ways to leverage their clinical talent-from technology for consumer self-service to service process reengineering to performance-based compensation-these are continuous improvements needed to maintain margins in a time of increasing costs of talent and competitive rates.
For more, check out these resources from our senior team in the OPEN MINDS Industry Library:
- Enhance Productivity!
- Business Process Management-Coordinating Your Assets For Better Performance
- How To Tackle Performance-Based Compensation
- Models For Physician Compensation & Productivity Management: How Provider Organizations Are Negotiating Clinical Staff Contracts
- The Value-Based Reimbursement Steeplechase
- Value-Based Reimbursement-The Numbers Are In
- Innovation In Addiction Treatment: The New Community-Based, Tech-Enabled Models
- From Consumer Engagement To Consumer Activation
- Task Shifting To Bend The Cost Curve
- Planning For The Digital Reinvention Of Your Market
For more on compensation, join me on September 18 at The 2018 OPEN MINDS Executive Leadership Retreat for the session, “Executive Compensation: How To Negotiate & Manage The Compensation Process,” featuring OPEN MINDS Advisory Board Member, Richard Louis, and OPEN MINDS Senior Associate, George Braunstein.