Question: When we have a shared visit (physician as rendering provider and mid-level provider as assisting), how should we credit the physician for the services under a wRVU compensation system?  

Here's some background: We are a 40-provider (20 physicians and 20 mid-level providers) physician practice and are designing a wRVU based compensation system. Our specialty is pulmonary and critical care medicine, so we perform services in the hospital as well as in the clinic setting. For hospital-based services, our physicians use mid-level providers to assist in patient care. If it meets the qualifications for a "shared visit," we bill these services under the physician's national provider identifier. It is been suggested that we give the physician 80 percent of the wRVU, but we are seeking any other suggestions or ideas.

Answer: I believe the hospital and clinic settings should be separated with regard to an incentive program. Here's why: In a hospital setting, a pulmonary or critical care physician (or mid-level provider) often is functioning as a hospital-based physician, such as a hospitalist, emergency department physician, radiologist, pathologist, or anesthesiologist. The physician treats the patients as they are presented to him or her. The physician has little impact on the number of patients treated, or the types of services provided, in a given period of time. The physician simply provides the best care they can give to patients whom are already there. I believe that is why RVU-type incentive programs are rarely used for hospital-based physicians.

I believe RVU incentives should be limited only to services provided in the clinic setting, where such incentives can be properly aligned for both the individual physicians and the overall physician practice.

If incentives are desired for providers of hospital-based inpatient care, a non-RVU type of incentive would probably work best. Perhaps the hospitalist service at your hospital has developed one that would also work for your specialty.


This question was answered by Robert J. Ellertsen, FHFMA, interim CFO, Department of Medicine, Beth Israel Medical Center, and a member of HFMA's Massachusetts-Rhode Island Chapter (rellertsen@aol.com).

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Publication Date: Thursday, November 15, 2012