Increases in primary care physician income due to the Patient Protection and Affordable Care Act of 2010 - continued tweaking of physician payment.

The Patient Protection and Affordable Care Act (ACA) authorizes several changes to the Resource-Based Relative Value Scale (RBRVS) system that are designed to increase primary care physician personal income and reduce geographic variation in primary care payment. In this brief, the ACA-authorized primary care payment adjustments are modeled in a prototypical rural primary care practice to assess both the potential impact on physician personal income and the likelihood that the changes will achieve the desired policy outcome. Key Findings. (1) The Patient Protection and Affordable Care Act (ACA) increases physician personal income in a prototypical primary care practice an average of $3,537 (1.9%) in 2010 compared to baseline income as if the ACA were not enacted. In 2011, physician personal income in a prototypical primary care practice increases by an average of $12,013 (9.3%) compared to baseline. (2) Due to Geographic Practice Cost Index (GPCI) changes legislated by the ACA, physician personal income increases are greater in entire-state Medicare payment localities than in states with multiple Medicare payment localities. (3) The requirement that at least 60% of a practice's furnished services must be specific "primary care services" to receive the ACA primary care bonus may eliminate eligibility for rural primary care practices that tend to offer more procedures (thus proportionally fewer primary care services) than urban/suburban practices. (4) The ACA primary care payment increases may be too small to have a significant impact on primary care and rural physician shortages. Targeted and significant primary care payment bonuses may be a more effective policy to reduce specific physician shortages.