Are You paying Your Physicians Market Competitive
Transcription
Are You paying Your Physicians Market Competitive
Are You paying Your Physicians Market Competitive Compensation? How Do You Know? Use of the MGMA Physician Pay-to-Production Plotter to Determine Market Competitive Compensation for Physicians Ken Robbins, MD Executive Vice President and Chief Medical Officer Hawaii Pacific Health What is Hawai‘i Pacific Health? Hawai‘i's Largest Health System 4 hospitals; 49 outpatient clinics & service sites 3 physician groups w/ 350 employed physicians and 1,300 affiliated physicians Market Share: 34% inpatient 10% outpatient Top 10 Hawai‘i companies in total revenue w/ over 5,400 employees 553 acute care beds and 76 bassinets Operating statistics: 34,278 admissions 27,895 surgery cases 119,944 ER visits 6,917 deliveries 1 FY10 data. About Hawai‘i Pacific Health • Largest Health Care System in Hawai‘i • Four Hospitals • Two Multispecialty Clinics – Straub Clinic & Hospital – Kaua‘i Medical Clinic • One Academic Pediatric Faculty Group 2 The Physician Compensation Plan at Hawai‘i Pacific Health • • • • Professional Revenue Minus Expense Model. 2-15% Incentive for Quality, Service. 15% for Administrative Adjustments. MD Compensation changes every 4 months based on rolling 12 month performance. • Benchmark to MGMA, AMGA, Sullivan/Cotter. - Compensation vs. Work RVUs by Specialty. - Compensation vs. Collections by Specialty. 3 Table 1.1 Physician Compensation (More Than 1 Year in Specialty) All Physicians Specialty Allergy/Immunology Providers Practices Mean Std. Dev. 25th %tile Median 75th %tile 90th %tile 169 92 $326,463 $217,208 $188,049 $257,272 $374,119 $594,523 2,772 158 $356,178 $134,687 $267,365 $354,241 $427,800 $520,470 118 57 $502,307 $216,517 $353,309 $449,147 $614,674 $830,008 66 10 $423,928 $188,154 $301,801 $446,432 $477,100 $501,283 Cardiology: Electrophysiology 187 96 $514,797 $231,822 $349,172 $500,790 $611,358 $795,203 Cardiology: Invasive 543 145 $465,540 $180,524 $346,640 $440,840 $546,000 $683,120 Cardiology: Inv-Intvl 677 163 $533,088 $236,339 $380,000 $487,070 $622,401 $830,064 Cardiology: Noninvasive 572 160 $396,932 $175,841 $271,750 $370,807 $486,460 $602,253 Critical Care: Intensivist 93 16 $249,306 $56,068 $221,489 $239,707 $266,731 $322,450 Dentistry 23 12 $137,135 $48,597 $100,000 $114,351 $171,820 $205,600 313 120 $371,330 $190,034 $259,118 $321,180 $452,164 $567,963 32 22 $624,932 $371,611 $387,028 $537,665 $680,688 $1,199,491 Emergency Medicine 754 57 $244,842 $63,800 $207,437 $243,449 $281,220 $319,644 Endocrinology/Metabolism 198 103 $205,874 $75,023 $159,590 $189,055 $226,181 $289,347 Family Medicine (w/ OB) 1,206 201 $181,650 $66,800 $140,636 $170,693 $210,804 $259,219 Family Medicine (w/o OB) 4,877 550 $175,902 $70,161 $130,413 $160,729 $203,428 $261,222 42 30 $205,175 $96,185 $147,129 $196,093 $234,603 $337,445 869 203 $423,907 $196,915 $292,848 $384,015 $518,241 $663,136 Anesthesiology Anes: Pain Management Anes: Pediatric Dermatology Dermatology: Mohs Surgery Family Medicine: Sports Med Gastroenterology Source: MGMA Physician Compensation and Production Survey: 2006 Report Based on 2005 Data 4 Table 5.1 Physician Collections for Professional Charges (TC/NPP Excluded) All Physicians Specialty Providers Practices Mean Std. Dev. 25th %tile Median 75th %tile 90th %tile 64 43 $555,265 $364,292 $264,788 $514,868 $719,954 $901,012 1,286 84 $475,706 $241,889 $326,559 $434,716 $571,687 $749,863 Anesthesiology: Pain Management 34 20 $835,707 $401,558 $630,851 $744,042 $976,632 $1,436,632 Anesthesiology: Pediatric 10 3 $314,164 $68,868 $279,245 $307,105 $307,105 $480,810 Cardiology: Electrophysiology 42 21 $789,590 $354,690 $527,516 $716,614 $927,712 $1,336,421 Cardiology: Invasive 127 40 $748,281 $249,430 $587,002 $711,659 $897,173 $1,047,129 Cardiology: Invasive-Interventional 162 42 $811,932 $387,479 $581,970 $756,520 $945,558 $1,221,803 Cardiology: Noninvasive 122 38 $596,955 $335,564 $403,158 $542,532 $718,654 $964,418 Critical Care: Intensivist 36 8 $233,850 $89,338 $163,516 $235,536 $299,959 $350,395 Dentistry 11 4 $335,436 $156,160 $230,307 $282,155 $520,291 $546,287 155 68 $768,385 $397,289 $524,976 $688,733 $855,760 $1,190,898 12 $1,380,375 $484,455 $1,041,142 $1,298,270 $1,609,432 $2,142,735 Allergy/Immunology Anesthesiology Dermatology Dermatology: Dermatopathology Dermatology: Mohs Surgery 16 211 15 $327,055 $104,031 $270,277 $324,145 $393,716 $459,972 85 45 $371,170 $173,665 $262,152 $323,980 $422,674 $561,146 Endocrinology/Metabolism 380 69 $384,086 $124,485 $302,999 $363,250 $444,027 $544,332 Family Medicine (with OB) 2,039 213 $360,457 $138,224 $276,416 $345,294 $423,468 $513,223 20 15 $345,574 $170,137 $206,739 $322,229 $461,415 $590,677 415 97 $766,004 $259,968 $599,495 $740,094 $878,215 $1,139,412 64 43 $555,265 $364,292 $264,788 $514,868 $719,954 $901,012 1,286 84 $475,706 $241,889 $326,559 $434,716 $571,687 $749,863 Emergency Medicine Family Medicine (without OB) Family Medicine: Ambulatory Only (No Inpatient Work) Family Medicine: Sports Medicine Gastroenterology Source: MGMA Physician Compensation and Production Survey: 2006 Report Based on 2005 Data 5 Table 20.1 Physician Work RVUs (CMS RBRVS Method) (NPP Excluded) All Physicians Specialty Providers Practices Mean Std. Dev. 25th %tile Median 75th %tile 90th %tile Allergy/Immunology 77 55 4,282 2,107 2,971 3,884 4,779 7,540 Anesthesiology: Pain Management 36 18 6,542 3,101 4,750 5,029 8,516 12,061 Cardiology: Electrophysiology 56 34 8,907 2,886 6,679 8,703 10,905 12,790 Cardiology: Invasive 192 66 8,425 2,924 6,336 8,278 10,589 12,390 Cardiology: Invasive-Interventional 226 66 9,327 2,733 7,404 9,198 11,302 13,292 Cardiology: Noninvasive 195 72 6,886 2,746 4,917 6,360 8,590 11,053 Critical Care: Intensivist 39 11 4,192 1,953 2,471 3,860 5,661 7,033 6 2 * * * * * * 186 74 7,048 2,641 5,052 6,976 8,958 10,621 8 8 * * * * * * Dermatology: Mohs Surgery 242 25 5,965 2,292 4,320 5,798 7,064 9,281 Emergency Medicine 130 69 4,177 1,287 3,394 3,920 4,668 5,784 Endocrinology/Metabolism 721 100 4,318 1,150 3,530 4,212 5,026 5,922 Family Medicine (with OB) 2,737 233 4,158 1,175 3,354 4,053 4,844 5,762 15 12 4,322 1,684 2,698 4,354 5,277 7,057 395 105 7,759 2,359 6,360 7,576 9,289 10,734 Family Medicine: Sports Medicine 77 55 4,282 2,107 2,971 3,884 4,779 7,540 Gastroenterology 36 18 6,542 3,101 4,750 5,029 8,516 12,061 Dentistry Dermatology Dermatology: Dermatopathology Family Medicine (without OB) Family Medicine: Ambulatory Only (No Inpatient Work) Source: MGMA Physician Compensation and Production Survey: 2006 Report Based on 2005 Data 6 Table 8.1 Physician Compensation to Collections Ratio (TC/NPP Excluded) All Physicians Specialty Providers Practices Mean Std. Dev. 25th %tile Median 75th %tile 90th %tile 51 38 0.532 0.175 0.435 0.535 0.616 0.804 1,061 79 0.699 0.179 0.576 0.668 0.848 0.943 31 19 0.651 0.149 0.494 0.673 0.750 0.835 * * * * * * 39 20 0.635 0.132 0.547 0.624 0.743 0.835 Cardiology: Invasive 114 39 0.644 0.164 0.511 0.650 0.780 0.840 Cardiology: Invasive-Interventional 150 40 0.663 0.175 0.534 0.648 0.803 0.918 Cardiology: Noninvasive 101 35 0.663 0.175 0.529 0.645 0.804 0.906 Critical Care: Intensivist 13 6 0.824 0.167 0.650 0.893 0.949 0.985 Dentistry 11 4 0.463 0.125 0.372 0.397 0.536 0.722 154 68 0.511 0.123 0.426 0.496 0.574 0.679 15 11 0.479 0.139 0.344 0.511 0.607 0.659 192 15 0.691 0.129 0.605 0.667 0.773 0.870 76 43 0.571 0.174 0.436 0.561 0.672 0.832 Endocrinology/Metabolism 376 69 0.505 0.133 0.413 0.478 0.582 0.689 Family Medicine (with OB) 1,954 210 0.507 0.148 0.410 0.483 0.579 0.718 18 13 0.522 0.130 0.382 0.532 0.610 0.723 395 95 0.537 0.151 0.425 0.516 0.634 0.719 51 38 0.532 0.175 0.435 0.535 0.616 0.804 1,061 79 0.699 0.179 0.576 0.668 0.848 0.943 Allergy/Immunology Anesthesiology Anesthesiology: Pain Management Anesthesiology: Pediatric Cardiology: Electrophysiology Dermatology Dermatology: Dermatopathology Dermatology: Mohs Surgery Emergency Medicine Family Medicine (without OB) Family Medicine: Ambulatory Only (No Inpatient Work) Family Medicine: Sports Medicine Gastroenterology 7 2 Source: MGMA Physician Compensation and Production Survey: 2006 Report Based on 2005 Data 7 Table 22.1 Physician Compensation to Physician Work RVUs Ratio (CMS RBRVS Method)(NPP Excluded) All Physicians Specialty Providers Practices Mean Std. Dev. 25th %tile Median 75th %tile Allergy/Immunology 60 44 $62.36 $17.72 $47.29 $60.53 $76.56 $86.93 Anesthesiology: Pain Management 30 13 $68.40 $14.91 $54.03 $72.17 $77.29 $87.91 Cardiology: Electrophysiology 54 32 $50.66 $15.20 $39.38 $49.38 $62.05 $67.08 Cardiology: Invasive 179 65 $55.41 $17.50 $42.91 $53.68 $66.29 $81.28 Cardiology: Invasive-Interventional 218 65 $53.45 $15.91 $43.20 $50.90 $62.46 $76.42 Cardiology: Noninvasive 174 68 $54.64 $17.30 $43.16 $51.15 $64.68 $81.93 Critical Care: Intensivist 30 10 $58.86 $17.35 $47.57 $55.70 $68.08 $90.98 * * * * * * 72 $50.56 $15.03 $40.93 $47.14 $56.53 $75.55 * * * * * * Dentistry Dermatology Dermatology: Dermatopathology 5 181 8 2 8 Dermatology: Mohs Surgery 235 24 $41.02 $12.88 $31.79 $39.41 $49.18 $57.78 Emergency Medicine 121 67 $47.65 $14.02 $38.64 $45.11 $54.55 $67.14 Endocrinology/Metabolism 717 99 $42.81 $10.08 $37.10 $41.41 $47.88 $56.44 Family Medicine (with OB) 2,699 232 $41.41 $11.29 $34.55 $38.89 $45.95 $56.05 15 12 $48.95 $18.38 $32.77 $44.80 $66.20 $74.92 362 99 $51.58 $15.34 $41.87 $48.35 $56.87 $73.60 Family Medicine: Sports Medicine 60 44 $62.36 $17.72 $47.29 $60.53 $76.56 $86.93 Gastroenterology 30 13 $68.40 $14.91 $54.03 $72.17 $77.29 $87.91 Gastroenterology: Hepatology 54 32 $50.66 $15.20 $39.38 $49.38 $62.05 $67.08 Family Medicine (without OB) Family Medicine: Ambulatory Only (No Inpatient Work) Source: MGMA Physician Compensation and Production Survey: 2006 Report Based on 2005 Data 8 90th %tile • Scenario 1: Are you paying Market Competitive Compensation for established MDs in Family Medicine (Without OB)? - MGMA Median Compensation is $200,114 - MGMA Median Comp/Collections is 51.4% - MGMA Median Comp/Work RVU is 42.73 9 10 11 12 Table 22.1 Physician Compensation to Physician Work RVUs Ratio (CMS RBRVS Method) (NPP Excluded) All Physicians Specialty Family Medicine (without OB) 13 Specialty 4,861 Practices 580 Mean $47.32 Std. Dev. 25th %tile $30.49 $36.57 Median $42.73 75th %tile 90th %tile $51.27 $63.62 14 • Scenario 2: Are you paying Market Competitive Compensation for Established MDs in Cardiovascular Surgery? - MGMA Median Compensation is $568,693 - MGMA Median Comp/Collections is 103% - MGMA Median Comp/Work RVU is 64.0 15 16 17 18 Table 22.1 Physician Compensation to Physician Work RVUs Ratio (CMS RBRVS Method)(NPP Excluded) All Physicians Specialty Surgery: Cardiovascular 19 Specialty 193 Practices 77 Mean $69.76 Std. Dev. 25th %tile $31.13 $49.55 Median $64.00 75th %tile 90th %tile $82.35 $106.61 20 MGMA Physician Pay-to-Production Plotter Live Demonstration Scenario 3: A noninvasive Cardiologist in your group (Dr. X) brings you a trade journal article which shows that the median compensation per Work RVU for noninvasive cardiology is $60 per Work RVU and he is only getting $50 per Work RVU. He is upset and demands an explanation and a raise in his pay. What do you do? 21 Thank him for coming by and tell him you will get back to him after you do some analysis. 22 • Gather Dr. X’s Compensation and Production data and compare to MGMA benchmarks for Noninvasive Cardiology: - Compensation: $600,000 (80th %tile) Work RVUs: 12,000 (90th %tile) Prof. Collections: $900,000 (90th %tile) Comp. to Work RVU: $50 (25th %tile) Comp. to Collections: 67% (40th %tile) • Plot Dr. X on the MGMA Physician Pay-toProduction Plotter 23 24 25 Table 22.1 Physician Compensation to Physician Work RVUs Ratio (CMS RBRVS Method)(NPP Excluded) All Physicians Specialty Cardiology: Non-Invasive 26 Specialty 450 Practices 123 Mean $72.37 Std. Dev. 25th %tile $38.93 $50.04 Median $59.88 75th %tile 90th %tile $84.39 $118.12 27 28 • Next steps: – Meet with Dr. X. – Review the scattergrams with him, which demonstrate that he is receiving market competitive compensation. – Be prepared for various reactions. 29 Conclusions and Lessons Learned • Pay market competitive compensation in order to recruit and retain the highest quality physicians to your medical group. • Understand the determinants of market competitive compensation to assure that your compensation formula pays your physicians appropriately. - Benchmarking Compensation to Productivity (Collections and Work RVUs) is still the standard. - As Pay for Quality and Service become more prominent, the benchmark standard will change. 30 Conclusions and Lessons Learned: Determinants of Market Based Compensation • Compensation per Work RVU decreases at higher levels of productivity. • 90th percentile productivity does not necessarily equate to 90th %tile compensation. • Compensation paid at or above the 75th %tile Comp. per Work RVU is generally above Fair Market Value. • One Standard Deviation around the best-fit line on the MGMA Pay-to-Production Scattergram usually constitutes market competitive compensation for that specialty. 31 Conclusions and Lessons Learned • The MGMA Pay-to-Production Plotter is a useful tool to help physicians gain an understanding of what constitutes market competitive compensation for their specialties. 32 Aloha! 33 Questions? Ken Robbins, M.D. Chief Medical Officer Hawai‘i Pacific Health [email protected] 808-522-3102 34