Value-based care initiatives are changing physician compensation

MedAxiom Consulting vice president Joel Sauer travels the U.S. visiting with clients and cardiovascular programs. Recently, he’s noticed an increased focus on aligning physician compensation around value-based care initiatives and keeping costs down while improving quality.

Last month, MedAxiom released its annual report that found the median compensation for cardiologists in 2014 was $542,000 per full-time equivalent. The compensation increased six percent from the previous year even though median production levels decreased for the fifth consecutive year to 9,538 work relative value units (RVUs) per full-time physician.

Meanwhile, the median non-clinical compensation ($45,457 per cardiologist) increased and accounted for nearly 9 percent of total compensation. Within a couple of years, Sauer expects non-clinical compensation to account for 20 percent of total compensation as programs focus more on value-based care.

“Work RVUs have been the historical currency, but they have one measure: work,” Sauer told Cardiovascular Business. “That’s it. They don’t have any indication of how well a physician is doing from a quality standpoint or even if the work was necessary. It just says you did it and therefore we’re going to count it. We’re seeing a de-emphasis of that as the only measure of physician compensation. We’re seeing programs move to these value indicators.”

Sauer has already seen how value-based care has affected cardiology practices. For instance, non-invasive imaging has declined in recent years, which coincides with appropriate use criteria.

“We’re trying to get more data on those non-clinical incentive opportunities, but it’s hard to get those data because the collection is not simple,” Sauer said. “The more complicated collection is, the less people want to participate because they just don’t have the time. We’re trying to figure out how to get good data around those non-clinical activities that are happening out there.”

The Centers for Medicare & Medicaid Services has made data available on the provider utilization and payments, while the American College of Cardiology and other societies have released cardiovascular data registries. Sauer envisions a future in which the public is more informed and physicians and hospitals are scrutinized more on how they perform with regards to healthcare costs and patient outcomes.

“It is the right thing,” Sauer said. “In very few other industries is there no tie to how well you do. It’s purely just about what you did, not how well you did it. Medicine hasn’t had that yet, and we’re getting it. I think we’re going to see an acceleration of this migration because it works but also because we have more data at our disposal to drive it. If you go back five years ago, the only thing we had was patient satisfaction and some really simple core measure activities. Now we’re moving well, well beyond that.”

-Tim Casey
Executive Editor