How are We Doing? Peer Survey Responses that May Surprise You

Thursday, April 19, 2018 | Joseph Sasson

How are We Doing? Peer Survey Responses that May Surprise You

If you missed the MedAxiom CV Transforum Spring’18 conference last week, you missed a lot. While there was enough content to fill plenty of blog posts, I’d like to focus on two topics today:

  1. The new MedAxcess database
  2. An exploration of audience responses to survey questions posed throughout the conference

First is MedAxcess, MedAxiom’s exclusive and powerful database that is available to all members. While the data inside the database can only be viewed in a de-identified fashion, it provides a number of measures to help assess areas of success and opportunity. MedAxiom unveiled an entirely new interface for the product, which can now be viewed much more effectively on mobile devices—including iPhones, iPads, and Android based phones and tablets—in addition to typical web-browser viewing. The design has a new dashboard functionality that makes digesting data quick and easy, as well as more advanced features that enable finer grain analyses without many additional clicks. The graphs and user interface are much improved, and the export functionality to Excel and PowerPoint is better than ever. I encourage you to watch for the webinars (first one is May 8th), videos, and training announcements related to MedAxcess in the coming weeks to prepare you for the launch of the new version. If you happen to miss them, we will always meet with you one-on-one to make sure you are comfortable and fluent with the program—simply reach out to our membership and/or technical support teams to schedule a tutorial at your convenience.

On the audience survey front, there were 50+ questions asked over the three days of the conference. The results provide an incredible perspective on the pulse of CV programs nationally. On the surface we see a fairly healthy industry and outlook.

Over 46% of cardiology programs expect compensation to rise and 54% expect cardiology production to increase, indicating that some programs are expecting to work more and make less for the same amount of work conducted. The reasons for this are various, and can include internal costs and investments (e.g., in expanding care teams or population health activities), new clinical technologies such as FFR, IFR, and blood flow that can eliminate the need for a cath, contract renegotiations, additional staff, and potential reimbursement cuts or moving procedures from a higher paying place of service to a lower paying one (e.g., such as removing provider-based billing from a site due to market factors). Others feel that compensation and volumes will be relatively stable, and a few expect a decrease in production and compensation.

In CV surgery, 34% think compensation will rise and 66% percent expect it to stay the same. For CV surgery production, 20% believe it will rise and 80% expect it to stay the same. What is interesting about these numbers is the slight variation between compensation and production, indicating that some groups are anticipating increased compensation without a corresponding increase in production—the opposite of what some expect for their cardiologists. These increases may come from other means such as administrative compensation, renegotiated WRVU rates, or ancillary service offerings that will increase revenue without increasing WRVUs. They may also indicate the movement of peripheral vascular procedures to a physician-owned OBL or ASC. We’ll be looking forward to analyzing the real data when it arrives.

On the strategy side, 39% of respondents indicated that their strategic plan is almost entirely focused on volume growth, which is unsurprising given the attention on market share and the fact that managing patient lives at greater economy of scale will continue to be beneficial in both value-based and fee-for-service-based payment models. It’s also possible that the discrepancy in dollars vs. production noted above comes from improved efficiency for CV surgeons, and from cardiologists who might feel less optimistic that they can achieve those improved efficiencies. Seventy four percent of respondents indicated that their organization is most focused on internal performance improvement, such as reducing cost, correcting staffing inefficiencies, embarking on quality improvement efforts, and so on. However, while that is a major focus, 22% of respondents specifically indicated that their biggest challenge today is actually achieving meaningful performance improvement, and when you add in those who responded “all of the above,” you arrive at a whopping 47% of programs that feel challenged to achieve what they are most focused on achieving.

A final question that fits with these issues is related to CV governance structure; when asked about the effectiveness of the governance structure, less than one third of respondents felt that their structures were nimble and effective.

When asked about the effectiveness of the governance structure, less than one third of respondents felt that their structures were nimble and effective.

Where does this leave us? In short, we’re expecting/hoping to make gains from a monetary standpoint while not losing ground in volume, but how we arrive at those numbers appears to be changing. The overall relationship between volume of WRVUs and income will always be a positively correlated one, but some practices are going to have to try to influence income through other means, which certainly includes cost-cutting measures and focusing on new non-WRVU-related revenue streams. However, achieving those gains involves having a solid governance structure that enables effective decision-making, resource allocation, and execution, and that is where many feel somewhat challenged. With an effective governance structure in place (or even not in place), the major focus for most organizations is performance improvement, yet nearly half of organizations see that improvement as a major challenge. If you’re aiming for higher revenue and maintaining or growing volume, and have performance improvement as a mandate, yet feel challenged by your governance structure and ability to drive change—you might need some help.

If this sounds like your organization, then it’s time to optimize your governance structure, get your team aligned on compensation methodologies, identify high-value opportunities for performance improvement, and make sure you have the internal or external resources and skills to help drive that change quickly. You can do it, and as always, we are here to help you.



Illustration: Lee Sauer

About the Author
Joseph Sasson

Joseph Sasson, Ph.D. is Executive Vice President of MedAxiom Ventures. Joe's work includes helping MedAxiom members to access the technologies and solutions they need most to effectively run their organizations and prepare themselves for the future of value-based care. Simultaneously, Joe works with dozens of companies in med-tech, device, pharma, imaging, cath labs/ASCs, and health IT to deliver economic value propositions and strategies to help companies accelerate commercial growth.

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