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Physician compensation is poised to change dramatically with the implementation of the Affordable Care Act (ACA). Although the current approach to physician compensation bases payment on services provided, in the future, payment will be for outcomes and the value that the patient, health system, and society derive from them.
Accountable Care Organizations (ACOs) are one centerpiece of the ACA and symbolize the integrated delivery, cost, and quality paradigm. An ACO is responsible for paying the physicians who render the services, working in collaboration with other professionals and organizations in the ACO. Further distribution of earned funds, including shared savings to physician participants, is structured by the ACO itself to further align respective participants’ interests.
Given that compensation will focus increasingly on outcomes—whether based on production, quality, efficiency, outcomes, or a combination of all these components—it should also eventually reflect market-based data to give organizations an ability to establish fair market value (FMV) for it.
There is no “one-size-fits all” answer viewing the future through today’s lens. A successful compensation model depends on a variety of issues. But to date, major innovative changes in physician compensation design have been held back due to regulatory and legal constraints on the market to implement significant compensation plan changes that align directly with, and clearly support, pay for outcomes goals.
On the regulatory side, there are numerous legal limitations on physician compensation. The regulatory scrutiny at the federal and state levels is fragmented and sometimes contradictory regarding guidance in terms of permissible (both legally and FMV compliant) physician compensation arrangements.
On the other hand, the compensation survey process offers a potentially more immediate and practical means to arrive at an FMV compensation approach, the effectiveness of which, however, depends on outcomes-based benchmark data that do not currently exist.
Those with valuation responsibility for compensation plan design must embrace the goal of developing new standards to establish FMV and commercial reasonableness for outcome-based physician compensation plans and help develop best metrics and methods of gathering this information during the next five years. Many hospitals will be increasingly reluctant to use physician compensation per wRVU benchmarks as the basis for measuring employed physician performance because the source of funding via ACOs and other arrangements will be based less and less on this very typical productivity-based metric.
By the same token, regulators must modify rules and regulations. The collaborative nature of the ACO model means that past definitions of anticompetitive conduct cannot be allowed to work at cross purposes to desired outcomes-based services.
Finally, hospitals should begin to design compensation plans that recognize and reward these desired behaviors. Collecting the requisite market data is essential to making such a change, and that collection must begin now.
Future CMS and commercial payer reimbursements for healthcare services will effectively require that the providers do more with less. To thrive in this new environment, healthcare providers must engage in activities that enhance higher accountability and a new service-oriented, results-based compensation culture within their organizations.
Rick is a managing director, healthcare practice, Navigant, Chicago.
Publication Date: Tuesday, January 22, 2013
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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