A Better Provider Productivity Measure: Moving Beyond the wRVU

Thursday, September 24, 2015 | Joel Sauer

For years now the wRVU has been the standard currency for measuring physician productivity, aka work.  According to a 2013 survey by MedAxiom, the majority of integrated hospital models employ a wRVU model for compensating physicians (MedAxiom 2013 Annual Integration Report).  Many private groups also use the wRVU within their internal distribution formulas as the best measure of individual physician effort.  Let’s face it, in a volume world the wRVU is a pretty good way to track physician production—not perfect, but pretty darn good. The question is, does it “measure up” as well in the value world?

Medicare and other third party payors are quickly moving away from total adherence to volume indicators (see Figure 1a).  The introduction of quality (outcomes) and population (alternative payment models) based reimbursement quickly expose the shortcomings of the wRVU.  First, the wRVU has no tie to quality or outcomes.  It simply counts whether a physician performed a CPT activity or not.  Related, the wRVU presumes that all production is good production.  From scientific evidence we know this isn’t the case.  Sometimes the best treatment is no treatment. 

Second, the wRVU is myopic to a single patient; there’s no measure or value given to assisting a population.  For example, chronic disease management requires a great deal of education and non-face-to-face encounters for a very broad (and currently largely unknown) group of patients.  The wRVU is ill-equipped to value these types of population-based activities and the broader care team required to pull them off.  Even at the individual patient level, the wRVU pretends that physician work is compartmentalized; that the care the general cardiologist provides is completely insulated from the interventional or EP physicians.  That's certainly not how the patient perceives it and works counter to a team approach – a critical need to be successful in a value economy.

Seeing the need to advance beyond the wRVU for three years now, MedAxiom has been collecting member data on cardiology patient panel size, the population of patients being actively managed by a group.  The definition of panel size is unique patient cognitive (E&M) encounters during the past 18 months measured at the group level. We believe panel size is the truest measure of a cardiology patient population, more so than physician FTEs and total cognitive encounters and may likely become a companion indicator of production to the wRVU. For sure it will become the standard denominator for many of the key measures and ratios in the MedAxcess database.

In our first year of data collection our sample size for patient panel was too small to be relevant.  Plus there were some known problems with the interpretation and consistency of the data definition that needed to be cleaned up. For 2015, we feel a high level of confidence in the panel size measure and trending will be available starting next year.

Figure 3n shows patient panel size data per FTE cardiologist. Table 3h provides some key volume indicators utilizing panel size as the denominator.

So as reimbursement moves away from volume measures and introduces payment for quality, cost and populations, does panel size make sense as a surrogate production measure to the wRVU?  Or perhaps as a companion production measure?  I think it does.  What are your thoughts?

Download here MedAxiom’s just-released 2015 Provider Compensation & Production Survey for FREE!

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