Compensation Models that Support Team-Based Care Models that Support Team-Based Care Fredrick T Horton, MHA, CMPE Vice President AMGA Consulting Services 1

Compensation Models that Support Team-Based Care

Fredrick T Horton, MHA, CMPE

Vice President AMGA Consulting Services

1

Presentation Overview

• Transition Planning

• APP Survey Data (with select physician comparisons)

– How NP/PAs are paid

– What NP/PAs are paid

• APP Compensation Models

• Physician Team-based Models

• Questions and Comments

2

Transition Planning

3

The Industry In Transition

1,730,000 Results

4

Pharmaceutical industry

Value over volume

Health secretary Murphy aims to shift payment model

From volume to value Payment model experiments a bold, significant step to transforming industry

NY Medicaid Program Steps Up Efforts to Shift Reimbursement System from Volume to Value

Forbes Insights Study Signals Imminent Health Care Shift Toward Value-Based Purchasing (VBP)

Effective Transitions…Are a Challenge

•Ensure Understanding of Marketplace Dynamics

•Evaluate Payor Environment

•Evaluate Culture and Readiness Planning

•Evaluate Capabilities

•Build Infrastructure

•Test Assumptions and Models Data

•Models and Reporting Capabilities

•Run Shadow Reports (validate)

•Agree upon Transition Details Build

•Develop Transition Models and Test

•Go Live and Monitor Results

•Refine as Appropriate Implementation

5

S O C I A L I Z A T I O N

APP Survey Data (with Select Physician Comparisons)

6

Survey Overview

• 29th Annual AMGA Provider Compensation Survey

• Data on clinical compensation, work RVUs, net collections, gross productivity, comp-to-productivity ratios, visits, and benefits

• 134 Physician Specialties

• 27 Other Provider Specialties

• NP and PA breakdowns

7

NP/PA Clinical Work Hours

8

25 to 30 hours per week, 2%

41 to 45 hours per week, 4%

31 to 35 hours per

week, 22%

36 to 40 hours per

week, 73%

NP & PA Clinical Hours (n=131)

Base Salary Determinants

9

81%

36%

33%

14%

8%

4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Market salary data

Percentage of last year's salary

Defined salary range

Percent increase based on budget

Percentage of concurent production

Panel size of work units

NP & PA Base Salary Determinants 2015 (n=98)

Current market data drives decisions about base pay in salaried models.

Production Models

10

Physician

NP/PA 2015

In production-based models, wRVUs are a major driver of pay.

Note the low “n” for NP/PA on this slide compared to the prior slide.

Incentive Pay Prevalence - Physician

11

45%

45%

23%

16%

14%

11%

11%

9%

9%

7%

5%

5%

5%

5%

5%

2%

2%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Patient Satisfaction

Individual Financial Goals

SCIP/Core/ACO Measures

Access

Other Incentives

HEDIS

Peer Chart Review

Citizenship

Dept RVU Goals

Market Adjustments

Dept Budget / Goals

Cost Containment

Controlling Outside Referrals

Accessibility/Availability

Other Discretionary

Seniority

Ancillary

NP/PA Other Incentive and Discretionary Compensation 2015 (n=44)

Incentive Pay Prevalence - NP/PA

12

The top categories are essentially the same for physicians and APPs.

The prevalence of various incentives across these categories tends to be lower for NPs/PAs.

Incentive Pay – 2015 Survey

13

Do you currently provide quality or performance incentives to APPs?

If so, how significant is the opportunity?

14

Number of Number of

Group Physician 90th 80th 20th Standard

Specialty Responses Responses Percentile Percentile Median Percentile Mean Deviation

Nurse Practitioner - Medical Specialty 114 1,567 128,297 116,729 100,855 88,659 104,532 26,074

Cardiology – Cath Lab (Invasive Interventional) 7 23 111,000 99,710 91,923 86,057 92,200 17,697

Cardiology – General 36 162 127,604 118,151 101,093 90,281 106,806 24,428

Dermatology 19 28 180,193 158,503 128,002 96,244 135,887 65,073

Endocrinology 24 59 118,309 105,806 95,549 82,608 98,018 24,119

Gastroenterology 21 50 116,287 104,431 96,284 82,806 96,327 13,706

Hematology and Medical Oncology 17 58 124,455 115,963 96,517 86,754 105,273 34,541

Hospitalist – Internal Medicine 15 46 134,731 129,974 106,539 91,793 107,710 30,068

Nephrology Only 7 10 130,812 118,749 97,912 90,457 109,426 31,816

Neurology 21 42 129,650 113,520 102,487 93,480 111,395 34,773

Occupational/Environmental Medicine 9 17 138,657 119,896 100,035 84,871 110,351 36,306

Palliative Care 14 49 112,643 105,287 96,571 88,234 97,750 22,948

Physical Medicine and Rehabilitation 12 20 115,194 111,438 92,269 81,273 94,490 18,811

Pain Management – Non-Anesthesiology 7 11 136,744 127,793 107,284 94,014 114,375 21,576

Psychiatry 12 25 148,814 126,115 104,351 91,120 111,076 38,120

Pulmonary Disease (Without Critical Care) 13 27 115,148 106,607 94,701 77,813 92,690 26,180

Pulmonary Disease (With Critical Care) 8 34 117,429 112,375 98,735 74,675 95,396 22,276

Wound Care/Hyperbaric 8 20 124,506 114,524 100,799 90,407 104,179 14,917

Nurse Practitioner – Primary Care 133 2,566 141,136 122,292 100,780 86,715 106,530 31,075

Family Medicine 58 514 147,947 120,708 99,048 85,510 106,779 36,465

Family Medicine – Branch 7 75 136,111 119,613 103,370 89,250 107,256 25,195

Internal Medicine 50 254 140,763 123,397 101,172 87,997 108,577 31,749

Pediatrics and Adolescent – General 40 153 148,608 138,209 104,009 87,260 113,232 35,831

Urgent Care 26 98 134,153 116,362 98,099 85,772 103,140 34,750

Nurse Practitioner – Surgical Specialty 90 732 139,622 124,800 102,981 88,989 107,844 28,748

Pediatrics and Adolescent – Neonatology 9 50 138,840 132,556 115,000 104,803 117,697 18,554

OB/GYN – Obstetrics 9 26 141,003 126,078 103,203 90,046 113,014 42,959

OB/GYN – Maternal Fetal Medicine/Perinatology 5 11 113,092 112,658 104,333 95,189 108,138 25,260

Cardiac/Thoracic Surgery 6 14 152,454 144,405 114,899 106,107 124,611 27,953

Cardiovascular Surgery 6 11 125,092 124,967 110,618 102,233 110,684 16,233

Emergency Medicine 7 23 128,294 122,395 113,000 104,071 115,919 20,843

General Surgery 14 44 127,123 112,119 94,673 88,397 99,537 20,205

OB/GYN – General 35 159 147,659 132,714 104,431 88,794 110,174 28,850

Neurological Surgery 16 38 130,440 123,642 102,620 93,038 109,726 25,301

Orthopedic Surgery 11 27 225,442 168,773 110,714 90,211 130,731 59,506

Otolaryngology 12 12 120,530 102,689 89,636 80,943 91,291 22,748

Urology 16 25 126,620 111,442 100,376 82,789 99,821 17,687

Vascular Surgery 9 11 122,081 121,186 98,002 86,198 110,851 47,139

Nurse Practitioner and Physician Assistant Subspecialties

Total Compensation (2015)

National Data

Median NP compensation was consistent across major specialty groupings.

14

15

Number of Number of



Physician Assistant – Medical 94 1,011 136,571 123,588 102,804 88,650 107,667 29,672

Cardiology – General 26 90 127,398 122,864 103,172 89,999 105,228 16,880

Dermatology 20 35 232,362 188,374 128,175 105,474 153,371 74,917

Endocrinology 9 11 118,116 108,576 94,952 87,900 106,219 39,173


Hematology and Medical Oncology 6 14 130,261 112,512 95,917 89,413 106,917 32,437

Hospitalist – Internal Medicine 10 90 122,798 115,411 99,921 87,827 97,709 23,584

Neurology 17 44 120,828 117,472 98,422 86,767 103,458 30,428


Orthopedic – Medical 6 12 156,569 145,117 105,037 99,657 110,226 33,266

Physical Medicine and Rehabilitation 11 20 136,213 121,836 103,646 86,400 107,375 36,242

Pulmonary Disease (Without Critical Care) 9 11 112,475 108,692 86,121 82,605 98,817 43,160

Pulmonary Disease (With Critical Care) 7 24 135,817 124,934 103,510 94,173 108,473 19,392

Physician Assistant – Primary Care 104 1,443 151,565 130,333 105,060 88,243 111,521 32,480

Family Medicine 41 321 172,980 141,184 106,959 89,349 117,106 40,744




Urgent Care 27 155 188,427 144,553 104,548 94,264 120,084 37,695

Physician Assistant – Surgical 99 1,151 149,881 133,952 113,733 96,193 118,557 32,499

Cardiac/Thoracic Surgery 9 27 155,852 152,102 138,247 124,166 140,401 24,615



General Surgery 28 105 136,395 126,318 109,925 94,558 111,632 23,154

OB/GYN – General 19 42 133,560 125,596 107,669 94,236 109,258 18,857

Neurological Surgery 16 35 150,959 136,443 120,372 99,120 122,772 30,770


Otolaryngology 15 24 157,616 137,451 121,848 100,119 121,452 28,234

Plastic and Reconstruction 11 14 178,690 149,722 121,456 99,262 126,178 32,521

Urology 24 49 142,777 130,671 103,356 91,976 114,075 38,464

Vascular Surgery 11 19 159,622 129,604 106,750 92,872 124,482 55,916


Total Compensation (2015)

National Data

PAs show more variation even at median, particularly for procedural or surgical specialties.

15

16

From our field experience, we know that RVU-based plans are less common for NPs and PAs.

However, more and more groups are basing a component of their pay on production to promote efficiency and access.

Data show where production is more of an emphasis.

Number of Number of



Nurse Practitioner - Medical Specialty 93 946 3,814 3,155 2,084 1,112 2,263 1,306

Cardiology – Cath Lab (Invasive Interventional) 6 13 3,040 2,727 2,548 1,095 2,183 1,161

Cardiology – General 28 88 3,059 2,574 1,661 984 1,947 1,187

Dermatology 17 22 6,840 5,578 4,798 3,525 4,946 1,836

Endocrinology 20 42 3,424 3,014 2,435 1,520 2,367 1,097

Gastroenterology 18 34 2,462 2,123 1,611 1,136 1,623 632

Hematology and Medical Oncology 11 28 2,581 2,327 1,754 993 1,732 700

Hospitalist – Internal Medicine 11 33 3,322 3,011 1,766 727 1,931 1,079

Nephrology Only 3 6 *** *** *** *** *** ***

Neurology 15 24 3,199 3,158 2,339 1,350 2,319 892

Occupational/Environmental Medicine 5 9 *** *** *** *** *** ***

Palliative Care 10 37 2,834 2,528 2,127 1,356 2,027 665

Physical Medicine and Rehabilitation 7 8 *** *** *** *** *** ***

Pain Management – Non-Anesthesiology 7 10 7,137 4,007 2,874 2,487 3,579 2,391

Psychiatry 11 16 4,249 3,829 2,852 1,481 2,767 1,238

Pulmonary Disease (Without Critical Care) 7 13 3,094 2,857 2,248 1,345 2,163 816

Pulmonary Disease (With Critical Care) 7 25 4,572 3,078 1,653 949 2,129 1,451

Wound Care/Hyperbaric 7 8 *** *** *** *** *** ***

Nurse Practitioner – Primary Care 111 1,794 4,939 4,383 3,327 2,203 3,332 1,320

Family Medicine 51 349 4,652 4,191 3,322 2,260 3,287 1,221




Urgent Care 23 76 5,432 4,706 3,693 2,169 3,655 1,361

Nurse Practitioner – Surgical Specialty 67 422 4,222 3,489 2,174 1,137 2,407 1,422

Pediatrics and Adolescent – Neonatology 5 17 3,609 2,723 1,876 934 2,057 1,264

OB/GYN – Obstetrics 8 23 3,987 3,772 2,889 2,199 2,912 905

OB/GYN – Maternal Fetal Medicine/Perinatology 2 7 *** *** *** *** *** ***

Cardiac/Thoracic Surgery 3 8 *** *** *** *** *** ***

Cardiovascular Surgery 3 5 *** *** *** *** *** ***


General Surgery 9 16 2,399 2,230 1,478 1,217 1,604 579

OB/GYN – General 30 112 4,761 4,038 3,064 2,180 3,209 1,231

Neurological Surgery 9 13 2,586 2,456 2,104 1,039 1,762 775

Orthopedic Surgery 7 11 3,137 3,128 2,672 1,454 2,252 911

Otolaryngology 10 10 4,321 3,457 2,633 2,162 2,733 1,134

Urology 11 15 3,766 3,616 2,188 1,790 2,633 1,017

Vascular Surgery 7 9 *** *** *** *** *** ***


Work RVUs (2015)

National Data 16

17

Number of Number of



Physician Assistant – Medical 72 567 4,382 3,526 2,240 1,282 2,517 1,476

Cardiology – General 18 47 2,650 2,321 1,764 1,135 1,812 815

Dermatology 19 34 8,821 6,716 4,984 4,030 5,540 2,160

Endocrinology 5 5 *** *** *** *** *** ***


Hematology and Medical Oncology 4 8 *** *** *** *** *** ***

Hospitalist – Internal Medicine 6 49 3,404 3,205 2,542 1,608 2,424 911

Neurology 13 36 3,639 3,127 2,361 1,860 2,476 778


Orthopedic – Medical 5 8 *** *** *** *** *** ***

Physical Medicine and Rehabilitation 5 7 *** *** *** *** *** ***

Pulmonary Disease (Without Critical Care) 3 3 *** *** *** *** *** ***

Pulmonary Disease (With Critical Care) 6 15 3,171 2,542 1,382 838 1,614 1,013

Physician Assistant – Primary Care 83 990 5,385 4,735 3,733 2,615 3,714 1,386

Family Medicine 37 255 5,489 4,793 3,652 2,446 3,657 1,447




Urgent Care 23 105 6,181 5,361 4,364 3,696 4,517 1,361

Physician Assistant – Surgical 78 771 4,365 3,376 1,930 1,006 2,331 1,660

Cardiac/Thoracic Surgery 8 23 1,726 1,446 877 614 1,228 912



General Surgery 25 66 2,781 2,116 1,252 795 1,603 1,113

OB/GYN – General 16 34 4,043 3,598 2,603 1,802 2,710 1,050

Neurological Surgery 14 33 3,723 2,902 1,760 913 2,188 1,746


Otolaryngology 12 19 5,099 4,501 2,823 1,511 3,057 1,507

Plastic and Reconstruction 8 10 2,759 1,645 939 641 1,377 1,155

Urology 18 31 3,938 3,440 2,384 1,335 2,461 1,121

Vascular Surgery 7 12 4,516 2,154 1,243 811 1,793 1,487


Work RVUs (2015)

Again, you can see the areas where RVU production and RVU reporting tend to be higher.

National Data 17

Panel Size Data – 2015 AMGA Survey

18

Panel Size

Specialty

Number of Group

Responses

Number of Incumbent Responses

25th Percentile

50th Percentile

75th Percentile Mean

Std. Dev.

Family Medicine 35 1221 1,434 1,866 2,325 1,896 728

Family Medicine With Obstetrics

6 24 1,255 1,575 2,042 1,661 615

Internal Medicine 33 964 1,468 1,938 2,408 1,942 724

Internal Medicine – Office Only

6 38 1,213 1,542 1,892 1,569 536

Pediatrics and Adolescent – General

31 589 1,572 2,044 2,464 2,045 731

Nurse Practitioner – Primary Care

13 218 519 943 1,372 1,003 627

Physician Assistant – Primary Care

8 45 462 1,095 1,812 1,130 758

Consider your care model and whether you want to provide incentives for independent APP panels or if the role should be more focused on support and care coordination.

APP Compensation Models

19

Goals for APP Redesign

Align APP and Organizational Goals

Foster Physician/APP Collaboration

Enhance Ability to Recruit and Retain

Bonus Program Production

Service

Quality

Citizenship

APP Compensation Plan Goals

20

Goals for redesign tend to be similar to the organization’s goals and charter for physician compensation redesign.


• Even though there is great emphasis on value-based models and increased use of APPs, their compensation models have evolved slowly and differently from physicians.

• Creates a more acute need to manage transitions and implement multi-year plans that are typically not a one-size fits all.

21

Historical Market Practices

Mix of Roles

Lack of Focus on wRVUs

Limited Specialty

Differentiation

Longevity $

22

Resulting Environment and Challenges

Limited wRVU or other performance metrics

Longevity

• Impact on Wage Scales

• Deemphasize

• Productivity

• Satisfaction

• Team-based care

• Quality

Information tracking and policy development

Transition planning

23

Year 1 Years 2 to 3 Years 3+

• 100% Current plan

• Performance measure data collected

and tested.

• Shadow reports created.

• Identification of wRVU and non-

productivity metrics occurs.

• Education and communication

strategy developed.

• Multiple plans with similar

structure

• 4-6 market based ranges.

• Incentive component introduced

(same percentage of total):

• Productivity (wRVUs)

• Collaborating physician goals

• Service

• Quality

• Satisfaction

• Transition completed

• Limited number of ranges.

• wRVUs as equal driver vs.

incentive ($/unit)

• Standard number of

components

24

Transitioning APP Compensation

Education and Socialization

Transition Planning-Conceptual Models

Ranges and Plans

Urgent Care Primary

Care Medicine

Subspecialty Hospital Based

Surgical Subspecialty

Other

25

Transition Planning-Conceptual Models

Base plus flat bonus

• 25%ile=$2,500

• 50%ile=$5,000

• 75%ile=$7,500

• 90%ile=$10,000

Base plus $/wRVU @ 10%

• Base set at 90% of target

• $/wRVU @ 10% of market data

Base plus value incentive

• Base set at 90% of target

• 10% for value

• Quality

• Service

• Access

• Department Specific

• Range of awards

26

XYZ Medical Group- Sample Structure

27

Component Primary Care Medical Sub Surgical Sub Cardiology Urgent Care Inpatient

Base Salary 90% of TCC 90% of TCC 80% of TCC 80% of TCC 70% of TCC 90% of TCC

Incentive 10% of TCC 10% of TCC 20% of TCC 20% of TCC 30% of TCC 10% of TCC

Total at Target 100% of TCC 100% of TCC 100% of TCC 100% of TCC 100% of TCC 100% of TCC

Prod. Tiers X X X

$/wRVU X

Goal Based X X

XYZ Medical

Salary Plus Production Tiers

• If your intent is to provide some incentive for increased productivity or access but to prevent competition with other providers (physicians), this approach may be helpful

• Consider three or four tiers and work with market data (for example):

– Tier 1 (P25 production): Base plus $3,000




• Consider total market compensation; base salary needs to be a reasonable starting point

• Incentive linked to performance to create aligned Total Cash Compensation

28

These tiers may vary by specialty and by your base salary starting point (compensation philosophy).

Salary Plus Production Tiers

• For example, you could have a base salary for NP-Family Medicine of $98,000

• If production is 3,300 wRVU, it approximates median for an incentive of $6,000

• Total cash compensation would be $104,000 or just above median pay

29

90th 80th 20th

Specialty Percentile Percentile Median Percentile

Nurse Practitioner – Primary Care 141,136 122,292 100,780 86,715

Family Medicine 147,947 120,708 99,048 85,510

90th 80th 20th



Family Medicine 4,652 4,191 3,322 2,260

Salary Plus Production Multiplier • This approach is similar except that there is a small per-wRVU payment

• Consider a base of $95,000 and $4 per wRVU with production of 3,300 wRVU

• Then, compensation is $95,000 + [$4 x 3,300 = $13,200] = $108,200

• This approach may work well for APPs with their own panels where you are providing incentives for production and access

30

90th 80th 20th



Family Medicine 147,947 120,708 99,048 85,510

90th 80th 20th



Family Medicine 4,652 4,191 3,322 2,260

How should you determine the per wRVU rate?

Model out the impacts before you finalize your formulas!!!

Salary Plus Production and Quality Incentive

• In team-based care settings, you may wish to evolve to models more similar to physician pay formulas

• Again, think about what you are trying to accomplish with the model

• Consider, for example, the continuum of care for chronic populations like heart failure and cardiology NP/PA roles where you want to promote:

– Quality care provision

– Patient education

– Coordination of inpatient/outpatient/home-based care

– [Notice that wRVU productivity hasn’t been mentioned yet ]

31


• With several APP specialties, market data is limited but it can be directionally helpful

• Let’s develop a model that is predominantly base salary, with a production incentive and 10% quality incentive

32


• The market compensation data includes base, incentive and other compensation

• As dollars are shifted toward incentives, base salary may need to be lowered (or held in place)

• For this example, you might choose the following:

– Base Salary: Near median

– Production Tiers: P25=$2K, P50=$4K, P75 or higher = $6K

– Quality Opportunity: 10% of median compensation for specialty ($10,109) or 10% of actual base salary

33

90th 80th 20th


Nurse Practitioner - Medical Specialty 3,814 3,155 2,084 1,112

Cardiology – General 3,059 2,574 1,661 984

90th 80th 20th



Cardiology – General 127,604 118,151 101,093 90,281

In future years, pay increases may be directed to the production incentives.


So if there is a base of $98,000, wRVU production of 2,200, and 10% quality incentive:

– Base Salary: $ 98,000

– Production Tiers: $ 4,000 (P50=$4K, P75 or higher = $6K)

– Quality Opportunity (10%)*: $ 10,109

– Total Opportunity: $112,109

34

90th 80th 20th



Cardiology – General 3,059 2,574 1,661 984

90th 80th 20th



Cardiology – General 127,604 118,151 101,093 90,281

You might decide to have a higher incentive for production > P75.

*Paid based on goal achievement.


• Historically, many organizations minimized the role of wRVU productivity with APP compensation

• In cases where APPs work independently (carry large panels), production and access may be areas for incentives

• When the focus is on care improvement and quality outcomes, it may be advisable to limit the role of production and focus on care coordination and quality

• Quality goals may be the same, or supplemental to, the physician goals (e.g., cardiology Core Measures, ACC databases, etc.)

• Similar to physician compensation design, new pay approaches cannot always be additive; you may need to “switch around” elements of the compensation plan

• Production-based models are possible but market data on production levels and conversion factors are limited

35

Physician Compensation to Support Team-based Care

36

APP Supervisory Compensation

• Compensating physicians for APP supervision is prevalent in many health care systems.

• Compensation of supervision minimizes threats of competition and can assist in the development of a team-based culture and care delivery models.

• According to data collected for AMGA 2015 Medical Group Compensation and Productivity Survey the range of compensation for APP Supervision is approximately: – 25th percentile $2,245

– 50th percentile $5,000

– 75th percentile $10,734

37

APC Supervision

38

Team-based Models

• Stipend for supervision

• Tiered bonus based upon “team” panel

• Tiered bonus based upon “team” goals

– Quality

– Satisfaction

– Access

39

Elements of Plan

40

Specialty: Family Practice

Number of Providers: 5

Physician wRVUs Panel Size Adjusted Panel APP- Yes or No

Dr. A 6,500 2,100 2,100 Yes

Dr. B 4,500 1,800 2,200 Yes

Dr. C 5,200 2,250 2,500 Yes

Dr. D 5,500 1,700 2,800 Yes

Dr. E 4,750 1,650 1,700 No

Totals 26,450 9,500 11,300

Compensation per wRVU $46.54 Median Rate

Median Compensation $225,899 Total Cash Comp

Median Production 4,863 wRVUs

Panel Size Goal 1,800 Per Practice

Per Survey

Data

Practice

Defined

Key Data Elements

Starting Point- Current Model

41

Physician wRVUs $/wRVU

Dr. A 6,500 $46.54

Dr. B 4,500 $46.54

Dr. C 5,200 $46.54

Dr. D 5,500 $46.54

Dr. E 4,750 $46.54

Total Compensation

Starting Point- Production Based- Paid at Median Rate per wRVU

Total Comp

$302,510

$209,430

$242,008

$255,970

$221,065

$1,230,983

Production Compensation, Plus Supervision Stipend

42

Production Based, with Supervision Stipend if working with APP • Production Component driven by Personally Performed wRVUs • Stipend paid at $5,000 per APP supervised • Could reduce Compensation per wRVU to match current compensation spend

Production Based- Paid at Median Rate per wRVU, Plus Supervision Stipend

Physician wRVUs $/wRVU

Dr. A 6,500 $46.54 $302,510 $5,000 $307,510

Dr. B 4,500 $46.54 $209,430 $5,000 $214,430

Dr. C 5,200 $46.54 $242,008 $5,000 $247,008

Dr. D 5,500 $46.54 $255,970 $5,000 $260,970

Dr. E 4,750 $46.54 $221,065 $0 $221,065

Total Compensation $1,230,983 $20,000 $1,250,983

Total Clinical

Compensation

Total Production

Compensation

Supervision

Stipend

Production, with Team Panel Size

43

Production Based, with Panel Size bonus opportunity • Production Component driven by Personally Performed wRVUs • Panel bonus is based upon Physician and APP shared panel • May wish to align APP incentives with similar bonus opportunity (with reduced bonus level)

Bonus Panel Size Award

Level 1 <2,500 $0

Level 2 2,500 to 2,750 $5,000

Level 3 2,751 to 3,000 $10,000

Level 4 3,001 and over $15,000

Physician Panel NP Panel Team Panel wRVUs $/wRVU Prod $ Bonus Total $ wRVU Model $ Difference

Dr. A 2,100 NP A 1,200 3,300 6,500 $46.54 $302,510 $15,000 $317,510 $302,510 $15,000

Dr. B 1,800 NP B 1,400 3,200 4,500 $46.54 $209,430 $15,000 $224,430 $209,430 $15,000

Dr. C 2,250 NP C 900 3,150 5,200 $46.54 $242,008 $15,000 $257,008 $242,008 $15,000

Dr. D 1,700 NP D 800 2,500 5,500 $46.54 $255,970 $5,000 $260,970 $255,970 $5,000

Dr. E 1,650 None 0 1,650 4,750 $46.54 $221,065 $0 $221,065 $221,065 $0

Total Compensation $1,280,983 $1,230,983 $50,000

Model Impact

Team Based Care Model- Physician Paid Median Per wRVU, Plus bonus for Team-based Panel Size

Salary, Plus Team Goal

44

Salary, plus goal attainment based upon Physician/APP Performance

• Physician compensation salary paid at median

• Tiered bonus, based upon goal attainment:

• Level 1- $15,000

• Level 2- $20,000

• Level 3- $30,000

• May wish to align APP incentives with similar bonus opportunity (with reduced bonus level)

Physician Base

Dr. A $225,899 1 $15,000 $240,899 $302,510 -$61,611

Dr. B $225,899 3 $30,000 $255,899 $209,430 $46,469

Dr. C $225,899 1 $15,000 $240,899 $242,008 -$1,109

Dr. D $225,899 2 $20,000 $245,899 $255,970 -$10,071

Dr. E $225,899 1 $15,000 $240,899 $221,065 $19,834

Total $1,129,497 $95,000 $1,224,497 $1,230,983 -$6,486

Performance

Bonus

Total Cash

Compensation Original Impact

Performance

Level

Salary, plus Tiered Bonus, based upon goal attainment

Conclusions

• Planning and implementation of transition plans are the key to success in redesign: – Planning – Data – Build – Implement

• APP compensation design is undergoing significant changes in the marketplace

• By structuring your APP and Physician programs in a complementary manner you can: – Reduce tensions regarding competition – Successfully achieve recruitment/retention and care redesign goals – Support a culture of team-based care

45

Questions and Comments

46

Fredrick T. Horton, MHA, CMPE

(913)544-5560

[email protected]

Documents

Compensation Models that Support Team-Based Care Models that Support Team-Based Care Fredrick T Horton, MHA, CMPE Vice President AMGA Consulting Services 1