It’s Time to Reward Pediatricians for the Value They Bring
For years, pediatrics has been one of the lowest reimbursed specialties in medicine. According to 2023 data compiled by Medscape, pediatricians are the second lowest paid specialty. Many factors contribute to this reality. For example, in North Carolina, roughly 40% of births are covered by Medicaid, which historically pays less than commercial insurance. Pediatricians also have had less ability to negotiate commercially offered contracts than other specialties. And value-based-care has also been slow to accelerate payments in pediatrics.
Given the tremendous value that pediatricians bring to their communities, to their families, and to the children they serve, better rewarding pediatricians for that value only seems fair. Below are some suggestions based on my experience in working with pediatrics practices and speaking with peers and colleagues in the profession.
Understand Your Contracts
Pediatricians, like many other physicians in private practice, often just sign the contracts that payers and partners send, without taking the time to analyze what those mean to the bottom line, and sometimes without entering into discussions about them.
It’s not easy to change long-held reimbursement patterns in healthcare, and pediatricians are certainly aware that their work isn’t compensated like specialists who perform high-cost and complex procedures. But that shouldn’t stop them from exploring all the ways that they can advocate for themselves and their practices regarding compensation.
Embrace Change
Medicine changes quickly, both in terms of content and in terms of methods of payment. Pediatrics has historically been slow to have value-based-care arrangements created in a way that allows for participation and rewards for excellent care of children. However, there are now clinically integrated networks (CINs) that can help with both entering the quality and value-based incentive world and with fair reimbursement. Joining Accountable Care Organizations (ACOs) is another way to create shared savings payments to pediatric practices.
We, at Alo, frequently discuss these topics with independent practice owners. When we recently integrated the provider team from Village Pediatrics of Chapel Hill into Avance Care, opening Avance Care Pediatrics | Southern Village in Chapel Hill, its lead physician, Dr. Kimberly Gush, said she was excited by all of the wraparound services we could offer a pediatrics practice - things like technology, billing, legal, and staffing.
Plan Your Future
One requirement in today’s evolving healthcare landscape is for practice owners to plan ahead for potential partners, ownership and financial models, succession planning, and other factors that may impact a sustainable future.
Pediatricians haven't felt the same pressure to plan for the future as other independent specialty and primary care practices, who have faced consolidation by health systems for years. I predict this too will change - we will start to see more acquisitions of pediatrics practices. Independent owners should think about how they want to ensure a sustainable future, and which partners they believe will help them the most with that future.
Our goal at Alo is to help independent physicians and their patients thrive. This mission includes pediatricians. The same approaches we use with other primary care practices apply to pediatrics - for example, the Alo Clinically Integrated Network (CIN) to help with fee-for-service reimbursement that reflects the enhanced value that the participating network physicians provide. We also now work with Medicaid, which is vital to many pediatricians who serve that population.
Today’s pediatricians are practicing in a dramatically different healthcare environment than a generation ago. Renewing our commitment to healthy, sustainable pediatrics practices is one of the most important steps we can take toward improving health.
