Are You paying Your Physicians Market Competitive

Transcription

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
42
21
$789,590 $354,690
$527,516
$716,614
$927,712
$1,336,421
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
122
38
$596,955 $335,564
$403,158
$542,532
$718,654
$964,418
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
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
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
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
36
18
6,542
3,101
4,750
5,029
8,516
12,061
56
34
8,907
2,886
6,679
8,703
10,905
12,790
192
66
8,425
2,924
6,336
8,278
10,589
12,390
226
66
9,327
2,733
7,404
9,198
11,302
13,292
195
72
6,886
2,746
4,917
6,360
8,590
11,053
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
*
*
*
*
*
*
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
721
100
4,318
1,150
3,530
4,212
5,026
5,922
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
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
Family Medicine: Ambulatory Only (No
Inpatient Work)
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
114
39 0.644
0.164
0.511
0.650
0.780
0.840
150
40 0.663
0.175
0.534
0.648
0.803
0.918
101
35 0.663
0.175
0.529
0.645
0.804
0.906
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
376
69 0.505
0.133
0.413
0.478
0.582
0.689
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: Pediatric
Dermatology
Emergency Medicine
Family Medicine: Ambulatory Only (No Inpatient Work)
Gastroenterology
7
2
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
30
13 $68.40
$14.91
$54.03
$72.17
$77.29
$87.91
54
32 $50.66
$15.20
$39.38
$49.38
$62.05
$67.08
179
65 $55.41
$17.50
$42.91
$53.68
$66.29
$81.28
218
65 $53.45
$15.91
$43.20
$50.90
$62.46
$76.42
174
68 $54.64
$17.30
$43.16
$51.15
$64.68
$81.93
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
5
181
8
2
8
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
717
99 $42.81
$10.08
$37.10
$41.41
$47.88
$56.44
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
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: Ambulatory Only (No
Inpatient Work)
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
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

Are You paying Your Physicians Market Competitive

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