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Copyright © 2023 Becker's Healthcare. He cites the aging US population and high prevalence of chronic disease, as well as the growing need for preventive care thats been sidelined temporarily during the pandemic. Given that you list the sources, this seems like a stupid question, but where are you getting the info you're using? As of Jan. 1 2021 membership purchasers in AZ, CA, HI, NJ and UT are subject to taxation. General pediatrics and adolescent medicine posted the lowest 2020 median specialty compensation at $257,432. Corporations lead us to believe its taboo to talk about salary for their own personal gain. The data show that the percentage of physicians paid by a combination of two or more methods increased from 48.2% in 2012 to 59.2% in 2020 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, namely bonus. 237 Views, Mgma Physician Compensation 2021 Pdf. He noted that the starting salaries for PCPs reported in the latest AMGA survey illustrate the high demand for physicians in that sector. Could you re-upload it or provide a link? Median W-RVUs came in at 4,740 in family medicine, 4,861 in internal medicine, and 5,246 in pediatrics. 332 0 obj
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The question is, how do you create resiliency in an organization and retain the ability to keep paying rising compensation when revenues are going down? Physicians might ask, for example, what happened with patient volumes and how compensation was handled during the first wave of the pandemic and what the organizations compensation committee has planned in the event of another major disruption, Mr. Horton said. General surgeons: $439,196 (2.69 percent decrease from 2020) Internal medicine physicians: $288,558 (0.05 percent decrease from 2020) Neurologists: $325,278 (1.25 percent increase from 2020) OB . AMGA is the national voice promoting awareness of medical groups recognized excellence in the delivery of coordinated, high-quality, cost-effective care. Primary care nurse practitioner compensation increased 1.29%. What was surprising in AMGAs findings, is that the long-expected significant shift from paying physicians on value rather than predominately on volume still isnt gaining much traction in the marketplace. As of Jan. 1 2021 membership purchasers in AZ, CA, HI, NJ and UT are subject to taxation. Thanks. AMGA $586,345Merritt Hawkins 0.9% % change 2016 % change 2016 -17 data Compensation ranges from $348,173 to 545,900 Sullivan-P -1.0% In the 2020 MGMA survey, urgent care physicians were No. Orthopedic surgery posted the highest 2020 median specialty compensation at $631,900, followed by gastroenterology at $542,948, and general cardiology at $532,781. "Though the survey, conducted by AMGA Consulting, found very modest increases in compensation, there were significant decreases in productivity, which can be directly tied to the pandemic. Physicians should focus on organizations that will include them in financial decision-making, not insulate them from financial reality, he said. MGMA DataDive is your gateway to the unknown. AMGA Compensation Data gaspasser127 Oct 4, 2021 This forum made possible through the generous support of SDN members, donors, and sponsors. Stay tuned. The AMGA's survey found even higher compensation levels in urgent care. Solve all your PDF problems. Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory. The AMGA survey report is based on data collected from 398 medical groups representing about 190,000 clinicians. LifeStyle
Note: Several surveys were used to compile this report. Enter and space open menus and escape closes them as well. Mean compensation for men and women, mean incentive bonus and highest-paying states by mean compensation are from Medscape's "Physician Compensation Report 2021." Telehealth was used to treat a diverse set of patients with a variety of needs. Related: Physician Employment Market Stabilizing, Recruitment Executive Says. The 33rd edition of the AMGAs Medical Group Compensation and Productivity Survey is its most comprehensive ever, containing data from 317 medical groups, representing over 127,000 providers from 169 physician, advanced practice clinician, and other specialties. Telehealth provides a way for physicians to provide care while keeping patients safe in their homes. News and Reference What is Happening Now. Learn more. The Benchmark Surveys have been conducted in every even year between 2012 and 2020. . For immediate assistance during normal business hours of 7:00am to 5:00pm MT M-Th and 7:00 am to Noon MT on Friday, please call toll-free: 877-275-6462, ext. However, consistent over the 2014-2020 period, roughly 70% of practice revenue came from FFS and 30% from APMs. This report (PDF) provides a detailed look at the extent to which physicians are in practices that participate in medical homes and accountable care organizations (ACOs) as well as involvement in alternative payment methods (APMs). Operations Management Certificate Program. 4 Change from 2018-2019: Advance Practice Clinicians, Certainly, a need for a call to action has been heightened, as this market trend persists. 2020 Benchmark Survey. American College of Medical Practice Executives (ACMPE) Overview, Claim and Manage Continuing Education Credits, Click here if your organization is tax exempt. endstream
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The epic challenges of today will force new thinking and, hopefully, breakthroughs needed for not simply sustaining compensation levels, but leading to organizations that are truly resilient.. I have that and just need to incorporate it into the site but I'll plan to do that. Download the latest guides and resources for telehealth services. These are typically medians after surveying all physicians regardless of how many years out of training. The data reveals the devastating economic impact of COVID-19 on healthcare provider organizations and indicates that they may need to rethink their compensation models in order to remain resilient in the face of future disruptions.". How are the numbers presentedaverage salary of all physicians in that field from first year out of residency through those with 40 years of practice? MGMA has asked me to remove all their salary data including PHG data. Let me know what you think. API Documentation. Download Now (PDF) 2020 Benchmark Survey. Telehealth in 2020: Survey Data Show Widespread Use Across Most Physician Specialties and for a Variety of Functions. For press copies, please contact Matt Clarke. This is the biggest gap that we saw in all of the specialties, which clearly puts some pressure on organizations going forward, he said. And that is increasing demand for those physicians and, in turn, higher compensation. Fig. Great work! Member price $0.00. Join a network of over 60,000 healthcare management professionals to achieve a healthier world. Super cool and useful idea. Up and Down arrows will open main level menus and toggle through sub tier links. Of the specialties included in the report, orthopedic surgery saw the highest median compensation in 2020, at $626,297. Connect with industry experts to help solve your most difficult medical practice challenges. The data was collected prior to February 2020 and reflected physician salary prior to the onset of the COVID-10 pandemic. Sooner or later, a backlog of sick patients will need to be addressed. The following table highlights changes in compensation and productivity from 2018 to 2019 for certain surgical roles. In 2019, median compensation increased 3.52% and median productivity increased 0.9%. The review is based on 2,458 permanent physician and advanced practitioner search assignments that were ongoing or conducted by Merritt Hawkins/AMN Healthcare's physician staffing companies from April 2020 to March 2021. While some physicians have seen their median compensation climb, median compensation for many physician specialties remained flat or declined. About mgma 2019 compensation pdf physician. Data report: 2022 MGMA DataDive Provider Compensation Realizing Recovery, Discover more about MGMA DataDive Provider Compensation. Median compensation came in at $295,605 in the 2020 survey, up from $283,787 in the 2019 survey a substantial increase that occurred without an increase in W-RVUs, which remained flat at 4,895 in 2019. At the same time, we are seeing revised care models and rapid telehealth expansion. The goal of the Reimagining Residency grant program is to transform residency training to best address the workplace needs of our current and future health care system. G gaspasser127 Full Member Verified Member 5+ Year Member Physician Joined Apr 19, 2016 Messages 272 Reaction score 242 Oct 4, 2021 #1 Members don't see this ad. Find or become the candidate that exceeds expectations with our comprehensive career and hiring development resources. (AMGA release, 8/17; Cheney, HealthLeaders Media, 8/20). Data was collected from Oct. 6, 2020, through Feb. 11, 2021. In 2019, median compensation increased 4.46% and median productivity increased 0.44%. The Medical Group Management Associations annual Provider Compensation and Production Report, which included data from more than 168,000 physicians and nonphysician providers, found an average increase of 2.6% in primary care total compensation from 2018 to 2019, to $273,437. March 28-31, 2023 Hyatt Regency Chicago Chicago, IL Physician compensation was impacted significantly last year by the coronavirus pandemic. of care delivery. Compensation (including total pay, bonus/incentives, retirement), Productivity (work RVUs, total RVUs, professional collections and charges), Benefit metrics (hours worked per week/year and weeks of vacation). The report also revealed that asc nurses earned an average of $35. The site navigation utilizes arrow, enter, escape, and space bar key commands. No, the large language model cannot deliver medical care. Copyright 2023 Becker's Healthcare. A new American Hospital Association report takes a closer look at the biggest challengers to healthcare's status quo, and challenges traditional providers to be innovative to survive in a NP demand is quickly growing because nearly 100M Americans lack access to primary care, AANP president says. Most data is from 2020 or 2021, Edit: just fixed a bug where many of the non -MGMA salaries were mapping inaccurately. This report(PDF) provides a detailed examination of how physicians were compensated by their practices between 2012 and 2020. Covid-19 antibody treatments: Here's what the evidence says. API Pricing. There is also a subset of data for starting salaries which can be harder to find. Helping healthcare leaders achieve greater success in their organizations. Saved credit card is required for opt-in to autorenew. Physician Compensation Models Seeing Modest Shifts, Knowing Your Worth in the Physician Job Market, Medscape Physician Compensation Report 2019: Earnings Up, but Satisfaction with Compensation Is a Mixed Bag, Demystifying Urban Versus Rural Physician Compensation, Career Guide: February Residents and Fellows 2023, Physician Interview Questions and Answers, Why Picking the People You Work with Matters, Career Guide: November Residents and Fellows 2022. 2020 AMGA MEDICAL GROUP OPERATIONS AND FINANCE SURVEY INSTRUCTIONS AND DATA DEFINITIONS 1 . Listen to . As an indicator of overall primary care physician productivity to organizations revenues, its worth noting, Mr. Horton pointed out, that while compensation per W-RVU was up 2.6% in 2019, compared to the prior year, collections per RVU dropped by 1.6%. General Information . Nonetheless, the data also show a shift away from complete reliance on FFS between 2014 and 2020, as the percentage of physicians indicating all of their practices revenue comes from FFS decreased by 5 percentage points. The shift to more value-based compensation models will help organizations become more resilient against future economic downturns.". AMGAs members are concerned about this ongoing trend, and we suspect the industry-wide response to COVID-19 will speed up efforts to mitigate this pattern. We have now seen this same trend of divergent key metrics for several years in a row, and we have to wonder how long it can continue, given that the vast majority of revenue is still, by and large, generated via work RVU productivity, said Fred Horton, M.H.A., AMGA Consulting president. *, Fig. 1888. AMA members get discounts on prep courses and practice questions. Median W-RVUs sector wide were 4,847 in 2019, a negligible difference of -0.27% from the previous year. See more of our nursery rhymes and folk song lyrics. If you purchased an event, you will be receiving a follow-up email from our Learning Management System regarding the product/event purchased and no further action is required. Median compensation came in at $295,605 in the 2020 survey, up from $283,787 in the 2019 survey a substantial increase that occurred without an increase in W-RVUs, which remained flat at 4,895 in 2019. Amga 2020 medical group compensation and productivity survey. Orthopedic surgery posted the highest 2020 median specialty. New hospitalist compensation and productivity information is available via the 2010 physician compensation and production survey report, the medical group management associations (mgma) annual survey.however, hm leaders are urging restraint to group directors and individual hospitalists pining for the latest industry benchmarks. Overall physician productivity decreased 10.17% in 2020, down dramatically from the 0.56% increase AMGA reported for 2019. Spending hours pouring through hundreds of pages in pricey compensation reports is usually the only way to find this information but we did the legwork for you. The report on 2012-2020 physician compensation methods shows an upswing in compensation by multiple methods. Left and right arrows move across top level links and expand / close menus in sub levels. Policy Research Perspective reports, based on the surveys, provide detailed analysis of the data. One of the divisions 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. When combined, it is certain that change is taking place, but the ultimate landing place is far from clear.. August 20, 2021. Compensation per wRVU ratio increased by 2.14% in 2019, down from the 3.64% in 2018. Insure.com compared payers in various categories to review and rank the best companies currently. Gauging pandemics effect on compensation. Find an overview of AMA efforts and initiatives to help improv GME. The data generally show consistent participation increases for each ACO type since 2016, although participation in Medicare ACOs slightly decreased from 2018 (38.2%) to 2020 (36.7%). Tom Florence, president of Merritt Hawkins,partially attributed this to the growing number of older patients who require the services of specialists. An endocrinologist shares necessary steps to take to protect your kidneys. Surgical specialties presented the largest increase in productivity of any specialty group, with a median wRVU increase of 1.95%. Payment and Delivery in 2020: Fee-for-Service Revenue Remains Stable While Participation Shifts in Accountable Care Organizations During the Pandemic. Thank you. This report (PDF) describes the rapid uptick in physicians use of telehealth between Sept. 2018 and Sept. 2020. In surgical specialties, 2020 median compensation decreased 0.84%. In 2019, median compensation for all primary care specialties increased by 4.46%, median productivity increased by 0.44%, and compensation per wRVU increased by 2.6%. Make informed decisions for your practice through insights and benchmarks from industry-leading data analysis, reports and surveys. Enroll in autopay for my next membership renewal. Does anyone know if MGMA skews high or everywhere else skews low? Please, check the box to confirm you're not a robot. Compensation models will look different in the near future based on shifting productivity and demands on physicians and the industry overall, said Halee Fischer-Wright, MD, MGMAs president and chief executive officer. In this episode of Making the Rounds, learn about one resident's experience of not matching, offering insight on coping and how unmatched applicants can find a position. 2020 Medical Group Compensation and Productivity Survey Results. Enroll in autopay for my next membership renewal. A sample of medical specialties with more remarkable changes to the compensation per work RVU ratio are cardiology, gastroenterology, hematology/medical oncology, and neurology. In fact, the percentage of physician compensation paid out based on value actually declined slightly in 2019, to 7.6% from 7.8% in 2018. Medical. Kidney disease can be prevented, and even reversed in its early stages. In 2020, 58.0% of physicians said their practices used telehealth to diagnose or treat patients, 59.2% to manage patients with chronic disease and 50.4% to provide care to patients with acute disease. OCR PDF. Description of mgma physician compensation 2021 pdf. Instead, SullivanCotter found that organizations making adjustments to address revenue declines were instead reducing compensation, shrinking benefit plans, or opting for temporary furloughs to ride out the drop in patient volumes. Median clinician compensation increased 3.7% from 2020 to 2021, compared to a 0.1% increase from 2019 to 2020. The total compensation received by the physician and crna reported as direct compensation which may. COVID-19 highlighted the need for medical groups and health systems to reconsider their compensation plans so that they rely less on obligatory annual pay increases and more on incentivizing productivity that rewards valuable outcomes. 0
The exception was pediatrics, where median RVUs were the highest of all the primary care specialties in all four regions, topping out at 5,676 in the South. Or do you mind sharing it via DM? Read the House of Delegates (HOD) speakers' updates for the 2023 Annual HOD Annual Meeting. Primary care physicians saw compensation gains slightly behind those seen in 2020, with median total compensation reaching $286,525 in 2021. Council on Long Range Planning & Development, 2012-2018 Data on Physician Compensation Methods: Upswing in Compensation through the Combination of Salary and Bonus, Payment and Delivery in 2018: Participation in Medical Homes and Accountable Care Organizations on the Rise While Fee-for-Service Revenue Remains Stable, Updated Data on Physician Practice Arrangements: For the First Time, Fewer Physicians are Owners Than Employees, How Are Physicians Paid? The AMGAs survey found even higher compensation levels in urgent care. . %%EOF
the total annual clinical compensation for each physician from each specialty on the specialty code list. Learn more with the AMA. I think that primary care physicians can be optimistic that practice offers will remain abundant and compensation levels will hold., Urgent cares boom spurs substantial compensation increases. Drive in style with preferred savings when you buy, lease or rent a car. Tax & Finance. The AMGA survey is available to provider organizations for $1,600 for a printed publication or $3,200 for the online portal. Neurosurgery $746,544 thoracic surgery $668,350 orthopedic surgery $605,330 plastic surgery $539,208 oral & maxillofacial $538,590 vascular surgery $534,508 cardiology. Privacy Policy. 2021 pfs policies medical practice executive insights key 2021 medicare physician fee schedule (pfs) policies the 2021 medicare pfs conversion factor is $32.4085. And when it comes to physician compensation, the challenges created by the pandemic may have many physicians wondering what to expect in 2021, when the global and local impact of the pandemic hopefully begins to wane. Could anyone provide me a copy of the most up to date MGMA salary data? *Survey contains compensation and productivity data on all provider specialties. If you're curious about a specific field in recent years I can PM you data from ~2018 I have a copy of that. I can share what i have. Compensation from this report includes base salary, bonuses and profit-sharing contributions. COVID-19 has had a dramatic impact on the health care industry with productivity halting for many medical practices. The decline in physician productivity "was not surprising," said Elizabeth Siemsen, AMGA Consulting director.
The Medscape 2020 Physician Compensation Report, based on survey responses obtained from 17,000 physicians before the pandemic, found a 2.5% average increase in primary care compensation compared to 2019, from $237,000 to $245,000. AMGA Consultingassists healthcare organizations in navigating the changing industry environment. 2009 - 2021 Massachusetts Medical Society. 2020 was the first year in which less than half (49.1%) of patient care physicians worked in a private practice, a drop of almost 5 percentage points from 2018. Although the MGMA declined to predict the effects of the pandemic and associated economic conditions and the drop in health care organizations revenues effects on PCPs (and other physicians) compensation in the next few years, citing fluctuating economic conditions, the organization is following the situation closely. Youre better off asking people in your field to share their salaries. Fig. There have been concerns about physician shortages, which could be one explanation for higher compensation rates compared to productivity, said Andrew Swanson, MBA, vice president of industry insights for MGMA. In this report, we detail: the total annual clinical compensation for each physician from each specialty on the specialty code list. In this episode, Rae sits down with Advisory Board's Sarah Hostetter and Daniel Kuzmanovich to look back at those predictions and see what has changed in the physician landscape over the past year and what hasn't. A university hospital (or teaching hospital) is a hospital that provides clinical education and training to future and current doctors, nurses, and other health professionals, in addition to delivering medical care to patients. physician salary sources. The MGMAs survey found essentially the same trend: For most primary care specialties, compensation increases appear to be outpacing increases in productivity. This is just a little side project for me to learn to build a website, but it would be nice to be able to crowdsource data from people with their offers from across the country (kind of like levels.fyi for software engineers). See All. Current ArticleCharted: Here's how much physicians were paid in 2020. Private Practice Dropped to Less Than 50 Percent of Physicians in 2020. Should all be accurate now. The AMA is your steadfast ally from classroom to Match to residency and beyond. What you need to know about the forces reshaping our industry. When 100% of the nursing faculty at one upstate New York reported incivility as a major departmental issue, they reversed course. 2023 Advisory Board. Cookie Policy. If you purchased an event, you will be receiving a follow-up email from our Learning Management System regarding the product/event purchased and no further action is required. Anesthesiologists: $453,683 (2.57 percent decrease from 2020) Cardiologists (general): $518,750 (2.63 percent decrease from 2020) Dermatologists: $506,276 (1.59 percent increase from 2020) Endocrinologists: $274,402 (0.22 percent increase from 2020) Emergency room physicians: $380,099 (0.58 percent increase from 2020) Family medicine physicians: $273,291 (1.27 percent increase from 2020) Gastroenterologists: $538,908 (0.74 percent decrease from 2020) General surgeons: $439,196 (2.69 percent decrease from 2020) Internal medicine physicians: $288,558 (0.05 percent decrease from 2020) Neurologists: $325,278 (1.25 percent increase from 2020) OB-GYN: $357,266 (0.66 percent decrease from 2020) Hematology and medical oncology: $462,644 (1.39 percent decrease from 2020) Ophthalmologists: $416,333 (1.14 percent decrease from 2020) Orthopedic surgeons: $626,297 (0.89 percent decrease from 2020) Pediatricians: $255,352 (0.81 percent decrease from 2020) Psychiatrists: $299,250 (0.54 percent decrease from 2020) Pulmonary Disease (With Critical Care): $418,382 (1.41 percent decrease from 2020) Rheumatologists: $278,416 (0.48 percent increase from 2020) Urologists: $500,698 (2.82 percent increase from 2020), Anesthesiologists: 10,842 Cardiologists (general): 6,896 Dermatologists: 6,447 Endocrinologists: 4,471 Emergency room physicians: 6,111 Family medicine physicians: 4,575 Gastroenterologists: 6,787 General surgeons: 6,025 Internal medicine physicians: 4,413 Neurologists: 4,253 OB-GYN: 6,317 Hematologists/Oncologists: 4,357 Ophthalmologists: 7,381 Orthopedic surgeons: 7,431 Pediatricians: 4,605 Psychiatrists: 3,574 Pulmonary disease (with critical care): 5,744 Rheumatologists: 4,315 Urologists: 7,093, Primary care men: $269,000 Primary care women: $211,000 Specialists men: $376,000 Specialists women: $283,000, Orthopedic surgeons: $116,000 Ophthalmologists: $87,000 Otolaryngologists: $72,000 Urologists: $72,000 Cardiologists: $71,000 Radiologists: $69,000 Gastroenterologists: $60,000 Anesthesiologists: $55,000 OB-GYN and women's health: $48,000 General surgeons: $47,000 Emergency medicine physicians: $44,000 Pathologists: $42,000 Critical care physicians: $41,000 Neurologists: $39,000 Physical medicine and rehabilitation physicians: $37,000 Family medicine physicians: $27,000 Internal medicine physicians: $26,000 Pediatricians: $26,000 Psychiatrists: $24,000, Family medicine physicians: $240,000 Radiologists: $50,000 Psychiatrists: $75,000 Internal medicine physicians: $100,000, Family medicine physicians: $2,500 Radiologists: $10,000 Psychiatrists: $1,000 Internal medicine physicians: $5,000, Highest-paying states for physicians by mean compensation, Alabama: $348,000 Kentucky: $340,000 Oklahoma: $338,000 Indiana: $337,000 Missouri: $332,000 South Carolina: $332,000 Florida: $331,000 Georgia: $330,000 Iowa: $330,000 Tennessee: $329,000, Highest offered base salary (Bonuses and benefits not included), Family medicine physicians: $400,000 Radiologists: $825,000 Psychiatrists: $400,000 Internal medicine physicians: $500,000 OB-GYN: $750,000 Anesthesiologists: $750,000 Hematologists/Oncologists: $1 million Gastroenterologists: $750,000 Cardiologists (non-invasive): $700,000 Cardiologists (interventional): $1 million Neurologists: $850,000 Orthopedic surgeons: $1 million Dermatologists: $1 million Pulmonologists: $650,000 Pediatricians: $400,000 Endocrinologists: $325,000, Lowest offered base salary (Bonuses and benefits not included), Family medicine physicians: $180,000 Radiologists: $150,000 Psychiatrists: $185,000 Internal medicine physicians: $170,000 OB-GYN: $207,000 Anesthesiologists: $245,000 Hematologists/Oncologists: $180,000 Gastroenterologists: $125,000 Cardiologists (non-invasive): $350,000 Cardiologists (interventional): $400,000 Neurologists: $215,000 Orthopedic surgeons: $300,000 Dermatologists: $200,000 Pulmonologists: $250,000 Pediatricians: $180,000 Endocrinologists: $200,000. The 20 specialties with the lowest average annual compensation. A State Sales tax exempt certificate must be on file and taxable items cannot be ordered online. Englewood, Colo. (May 21, 2020) - Medical Group Management Association (MGMA) released its 31st annual Provider Compensation and Production Report, the most comprehensive view of provider compensation in the United States.Despite the uncertainty surrounding the COVID-19 pandemic, MGMA received supplemental data with a 14% increase in total participating providers in early 2020, representing . 10.6% of weekly visits were conducted via videoconferencing and 8.1% were conducted via phone. 2021 report based on 2020 data survey methodology. We help leaders and future leaders in the health care industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution. The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. Heres that breakdown, from MGMAs 2020 DataDive Provider Compensation Report: MGMAfamily medicine average total compensation: $258,947, down slightly from $268,954 in 2018, MGMAinternal medicine average total compensation: $268,658, up from $258,323 in 2018, MGMApediatrics (general) average total compensation: $232,409, essentially flat compared with $232,701 in 2018, Although regional compensation variations are generally less pronounced than they were five or 10 years ago, because most organizations consider national data when setting their compensation structures, the MGMA survey did find some notable differences between the Eastern region (with a median of $257,757) compared to the other regions: $273,578 in the Midwest, $276,654 in the Southern region, and $279,626 in the Western region. AMGA | One Prince Street, Alexandria, VA 22314-3318 703.838.0033 phone 703.548.1890 fax Pre-exposure prophylaxis is one of the Affordable Care Act (ACA) preventive services at risk in federal court, says Stephen Parodi, MD. For example, if a physician pays a np $100 each and every time the np refers a patient to the physician for medical care, then it is very likely that the physician is giving and the np is receiving.