I agree with my good friend David - to some degree. This is a matter considerable debate and a degree of contention in most group practices. As groups have become more sub-specialized, and more age and gender diverse, and volumes have increased simultaneously with payment reductions, multiple procedure discounts and regulatory mania, coupled with MACRA/MIPS, the discussions and debates with respect to "compensation" have become of greater interest.
In addition, the need for increasing non-clinical participation to the practice in activities instrumental and important to
demonstrating value to the group's "customers" - hospitals, ordering physicians, patients and health plans is ever more important - but do not generate Work Rvu's. How are you recognizing these important contributions for the entirety of the group practice in compensation decisions?
Most practices set a baseline "salary" and then distribute excess earnings equally to all partners. Many practices have "compensation adjusters" such as days off after call, extra shift pay differentials, night call differentials and other "incentives".
Basing "bonus" payments upon Work Rvu metrics, in order to be instructive to the compensation committee, needs to include "hours worked" as part of the calculation.
I suggest physician leaders, with your guidance and assistance, develop a "value line" for the practice. Merely paying for production is a disservice to the partners, as well as associate physicians and will send a clear message to new recruits with respect to the culture of the group.
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Douglas Smith FRBMA
President & CEO
Phase 4 Radiology Business Strategies, LLC
Canton GA
770-213-4605
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Original Message:
Sent: 02-23-2018 09:47
From: David Smith
Subject: Radiologist Pay Structure
I would caution that work RVU's are not a very fine measure of anything, having been distorted over the years by various political forces in order to drive payment rates. It doesn't take much of a review to see that certain procedures/modalities are more highly valued than others relative to the work effort involved. This is also evidenced by the fact that each year certain procedures have their work RVU's significantly adjusted up or down...even though the work involved didn't suddenly change.
I don't think it's wise to use RVU's for physician compensation unless there is an homogeneous case mix (i.e. all cases are equally over/under valued). Otherwise, you incent people to focus their efforts on reading high value cases.
One alternative might be for the group to establish it's own RVU scale, starting with the CMS numbers and adjusting to an agreed upon reality.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
Original Message:
Sent: 02-23-2018 09:31
From: Shannon Helton
Subject: Radiologist Pay Structure
One of my clients is a group in which the partners split profits equally despite the fact that they are a sub-specialty group. When work RVU's are reviewed, this causes a lot of discussion because the individual provider totals vary widely. So I am following this thread to see what ideas come up. I like the idea of base salary with bonus and the fact that it is not entirely dependent on volume.
Thanks!
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Shannon Helton, CPC
Client Manager
Change Healthcare
shannon.helton@mckesson.com
Original Message:
Sent: 02-23-2018 08:46
From: Sunil Patel
Subject: Radiologist Pay Structure
We are going through as well right now. We are trying to develop a structure that incentivizes team effort in all aspects and still provides flexibility.
What direction are you moving to?
We are thinking a base salary with bonus. The bonus would be tied to 80% Clinical and 20% non-clinical work. The 80% clinical would be broken down to 35% Volume, 35% wRVU and 30% internal metrics such as upward 360 degree peer review, referring/patient group satisfaction scores, TAT, etc.
Would like to know your thoughts of our structure.
Original Message:
Sent: 02-22-2018 07:03
From: Raul Arizpe
Subject: Radiologist Pay Structure
Our Radiologists are all contract employees and we are reevaluating their pay structure. Would anyone be open to discussing their Radiologist payment strategy? I would be happy to discuss what we are currently doing and what we are thinking about.
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Raul Arizpe
President
Desert Imaging
El Paso TX
(915) 577-0100
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