Association of Departments of Family Medicine Webinar October 29 2018 Presenters Vice Chair for Clinical Affairs Clinical Professor of Family Medicine Department of Family Medicine amp Community Health ID: 1047655
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1. A Primary Care Compensation plan based on panel size – a five year updateAssociation of Departments of Family Medicine Webinar October 29, 2018
2. PresentersVice Chair for Clinical Affairs Clinical Professor of Family MedicineDepartment of Family Medicine & Community HealthJennifer Lochner, MDMedical Director, UW Health Belleville Family MedicineCo-chair Primary Care Compensation Governance GroupAssociate Professor of Family MedicineDepartment of Family Medicine & Community HealthSandy Kamnetz, MD 2
3. Workshop OutlineOverview and UW Health storyQuestions20 minutes5 minutes3
4. Objectives1. Recognize difficulties in measuring and aligning PCP’s work with compensation in the context of shifting incentives from volume-based to value-based care2. Identify keys to success and pitfalls with a panel based as compared to RVU based compensation plan 4
5. The UW Health Enterprise5
6. UW Health Primary Care43 Primary Care Clinics in 32 locations365 primary care clinicians287,000 active patients medically homed at UW Health6
7. Primary Care Clinical Job DescriptionPopulation Management40-50 hours total office time 30-32 minimum patient contact hours per weekPhysical presence in clinic from 8:00-5:00Clinical CareMaintain a weighted panel size of 1,800-2,200 Disease registries Preventative health careClinic-level quality improvement projectsWork in teams with Advanced Practice Provider7
8. Compensation Plan EvolutionOriginal Compensation Plan (100% RVU)Compensation based on both clinic and individual level metrics (panel size, RVUs, quality metrics)New Primary Care Compensation Plan Compensation based on individual RVU’sPhysician in control of own salary8
9. Details of UW Primary Care PlanCompensation pool = Benchmark salary/1800 target panel size ($133.27 per patient for 2019) x panel size at the site (or group of sites) =9Fiscal yearBlended Benchmark Salary for FM (MGMA, AMGA, McGladrey&Pullen)2015$220,9612016$223,8622017$225,1272018$233,3412019$239,886
10. Details of UW Primary Care PlanAll medically homed patients at a single clinic site or several sites pooled10C = CommunityR = Residency
11. 80% panel-based compensation Individual clinical FTE* Total clinical FTE for all residency faculty20% RVU-based compensationIndividual RVU productivityTotal RVU productivity for all residency facultyResidency Faculty Clinical CompensationNational benchmarkfamily medicine salaryTarget panel sizeTotal panel size for all residency clinics × $220,0001,800 patientsResidency Compensation Pool = $3,911,1110.5 FTE patient care +0.1 FTE precepting18 FTE across 4 clinics×80% of compensation pool32,000 patients across 4 clinicsTotal clinical compensation for residency physician with 0.6 clinical FTE = $133,6293,000 personal RVUs80,000 RVUs across 4 clinics× 20% of compensation pool50% panel-based compensation Individual panel sizeTotal panel size at clinic50% RVU-based compensationIndividual RVU productivityTotal RVU productivity at clinicCommunity Faculty Clinical CompensationNational benchmarkfamily medicine salaryTarget panel sizeIndividual clinic panel size × $220,0001,800 patientsCommunity Compensation Pool = $855,5562,000 patients7,000 patients at clinic× 50% of compensation pool7,000 patients at clinicTotal compensation for community physician with 1.0 FTE and a panel size of 2,000 patients = $217,2844,000 personal RVUs18,000 RVUs at clinic×50% of compensation pool
12. Additional details of UW Primary Care Compensation Plan 5% of clinical comp is at risk if clinical job description is not metMeeting attendanceChart completionParticipation in QI projects, teachingPhysicians can receive a 5% incentive bonus for meeting defined quality metricsPreventive care (e.g. breast cancer screening, vaccines)Chronic disease management (e.g. hypertension)Patient satisfaction (Press Ganey survey)12
13. Panel Weighting System - 2013Derived from 3 years of historical UW Health utilization data at PCP sitesWeightings range from 0.53 - 2.22Normalized Peds, FM, GIMPanels reflect office visit work done per patientAgeInsurance TypeGender13
14. SuccessesPhysicians report improved satisfaction with amount and methodology of compensation, appreciate getting off of the “RVU” treadmill
15. Areas that have been changed over timePanel weighting – of huge import when the weighted panel size is the key driver of compensation – goal is to weight based on predicted work in the PC officeReassess our weighting every year, 1 year look-backAccurate counting of the youngest age groupsIncluding non face to face encounters when counting the “work” of primary care – increasing phone and electronic messagingUsing RVU’s instead of # of office visits
16. UW Health Keys to Success16
17. Departmental keys to successAn active Primary Care Compensation Governance Group with senior and junior representation from all three primary care departments Each department was given some autonomy within the overall framework to craft a plan meeting its needs
18. Keys to Successful Transition AdministrationCliniciansStakeholder buy inDesign based on your goalsAlign work with compensation, recruitment, quality, accessSet a clear time frameMake measures meaningful and transparentHigh quality data analytics team18
19. Implementation LessonsOrganizational level issuesNeed for institutional supportNeed to continue to show value to the organizationNeed to decide whether to align with Primary Care SpecialtiesNeed to over-communicate at all levels19
20. Financial winners and losers in any new planBuild measurement tools to help enforce minimum clinical standards and to report quality dataImplementation LessonsDivision level issues20
21. Unintended Consequences of New Comp PlanRevert to meeting minimum job standards Increased policing with regard to meeting minimum standardsDecreased patient visits and RVU’s are difficult to explain in light of increased cost of comp planChange in roles of clinic staff/staffing modelsDifficult to justify levels with decreased patient visitsNeed to modify roles as part of team approach 21
22. Ongoing IssuesRefining how to measure workChanging national landscapePanel size, RVUs, Template hours, Quality?Being available in clinic is important with focus on managing patient panels and team carePrevious culture of individual flexibility in RVU model has changedEach doc in the clinic impacts the salary of the other docs in the clinic22Changing culture of physicians to team-based care
23. Questions????????23??
24. ReferencesKamnetz S, Trowbridge E, Lochner J, Koslov S, Pandhi N. A simple framework for weighting panels across primary care disciplines: findings from a large US. multidisciplinary group practice. Quality Management in Healthcare. 2018;27(4):185-190.Lochner J, Trowbridge E, Kamnetz S, Pandhi, N. Family physician clinical compensation in an academic environment: moving away from the relative value unit. Fam Med 2016;48(6):459-466.
25. Thank You!Contact Information:Jennifer Lochnerjennifer.lochner@fammed.wisc.edu608-424-3384Sandy Kamnetzsandra.kamnetz@uwmf.wisc.edu608-262-317125