Cardiologists’ median compensation tops $500,000

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 - MDs unaware is P4P included in compensation

In 2014, the median compensation for cardiologists increased six percent from the previous year to $542,000 per full-time equivalent, according to MedAxiom Consulting’s cardiovascular provider compensation and production survey.

MedAxiom vice president Joel Sauer, the report’s author, attributed most of the compensation gain to changes in the survey’s respondents. The number of non-invasive physician respondents decreased from 201 to 126, which is significant because non-invasive physicians are the lowest paid of the subspecialties.

Meanwhile, 31 more interventional physicians responded this year. Interventional physicians receive the most compensation. In all, private physicians’ compensation increased more than 10 percent to $470,000.

“We saw a very significant jump in overall physician compensation for cardiologists in the private cohort,” Sauer told  Cardiovascular Business. “That, intuitively, didn’t make sense to me. Nothing has changed with the economics of medicine from 2013 to 2014 that would suggest there would be a major compensation jump. As I dug into the numbers, I attribute the vast majority of that increase to a survey bias where we had a significant change in the respondents. If you have a significant change in the respondents from the lowest paid to the highest paid, that’s obviously going to move the median up. That’s what I believe happened.”

Median production levels decreased for the fifth consecutive year to 9,538 work relative value units (RVUs) per full-time physician and imaged stress studies declined for the fourth consecutive year to 272 per full-time physician. Sauer said there were multiple reasons why productivity has decreased, but the major driver has been changes in Medicare billing codes.

“If I did a procedure in the past, I would bill Medicare and third-party payers multiple CPT codes,” he said. “Now, they’ve taken those multiple codes and put them into a single code. Every time they do that, they reduce the net reimbursement but also the work RVUs associated with them.”

The survey’s respondents included 150 practices (113 hospital integrated practices and 37 private groups) representing 2,574 full-time cardiologists, cardiac surgeons and vascular surgeons.

MedAxiom’s membership includes more than 370 cardiovascular organizations and programs that are associated with more than 1,500 hospitals, 6,800 physicians, 3,500 C-suite leaders and 210 cardiology business and coding departments.

The median compensation was $584,854 for cardiac surgeons and $570,345 for vascular surgeons, while the median work RVUs were 11,653 and 9,085, respectively. Integrated surgeons had a median compensation of $592,804 compared with $434,546 for private surgeons.

Until three years ago, only MedAxiom’s members had access to the survey data. Since then, the data has been  publicly available.

For the past few years, non-clinical compensation has increased for cardiologists due to changes in reimbursement. In 2014, the median non-clinical compensation was $45,457 per cardiologist, which accounts for nearly 9 percent of total compensation.

“I wouldn’t be surprised if in a couple years, it’s at 20 percent of physician compensation,” Sauer said.

The largest component of non-clinical compensation is hospital-based incentives such as physicians helping hospitals reduce costs or improve the quality of their services or change utilization behaviors.

“A big deal right now is adherence to appropriate use criteria,” Sauer said. “That’s where societies like the American College of Cardiology say, ‘Here is when it is and is not appropriate to order echos or nuclear studies, et cetera.’ Now, our reimbursement is being tied to how closely we stay within those guidelines.”