Rural primary care physician payment 2006-2009: what a difference three years doesn't make.

(1) The 2007 Medicare Physician Fee Schedule Final Rule that increased compensation for cognitive (Evaluation and Management) services at a rate exceeding increases for procedural services resulted in modest increases in rural primary care physician income in a prototypical practice. (2) A prototypical cognitive primary care practice realized a higher percentage increase in income, but a prototypical procedural practice realized a larger dollar increase in income (due to a higher 2007 baseline income). (3) However, additional changes to the Medicare Physician Fee Schedule between 2006 and 2009 reduced intended primary care physician compensation increases, resulting in only minimal increases in primary care physician income when adjusted for inflation.