1. Jennifer Lochner, MD Brian Arndt, MD Beth Potter, MD
Moving away from the RVU: Care delivery changes with implementation of physician compensation reform
Jennifer Lochner, MD
Brian Arndt, MD
Beth Potter, MD

2. Disclosures
We have no conflicts of interest to disclose

3. Learning Objectives
Describe pros and cons of physician compensation plans based on RVU productivity as compared to panel size.
Adopt new metrics to assess changes in care delivery over time.
Consider local forces related to payer mix and department culture in decision making around changes to physician compensation plans.

4. This report includes 18 DFMCH clinics in and around Dane County, WI: 4 residency training sites, 10 community clinics and 4 regional clinics

5. Revenue Sources for our Clinics
Capitation
Fee for service
2011
34.7%
65.3%
2015
41.5%
58.5%

6. UW Health Primary Care Job Description
Formalized across primary care disciplines
Emphasis on team based care including panel management and population health as well as caring for individual patients
Defines work week as 27 hours face to face care, 13 hours non face to face care
Care model redesign implemented – new tools to address screening and chronic disease management during and outside of office visits

7. Key changes to the clinical compensation plan
Primarily based on panel size rather than RVU productivity – for 1.0 clinical FTE target panel size was set at 1800
Link to national benchmarks for FM clinical compensation
Maintain some aspect of RVU productivity in the calculation
For residency faculty minimize or remove any incentive to move patients onto faculty panels
Implemented for residency and community clinics but not for regional clinics
Residency clinics: 80% panel based, 20% RVU based
Community clinics: 50% panel based, 50% RVU based

8. What happened next?
RVU trends
Panel size trends

9. Trends in RVU per clinical FTE
2011 RVUs per FTE
2012 RVUs per FTE
2013 RVUs per FTE
2014 RVUs per FTE
RVU variance
National FM RVU benchmarkb
4796
4878
4901
4828
+0.01%
Residency clinics 
6099
6252 
4786 
4723 
-22.6%
Residency clinics
percentage of FM benchmark
127
128 98
Community clinics
3513 
4335 
4597  
4307
+22.6% 73 89 94
a New compensation plan started January 2013, retroactive to July 2012
b National family medicine Relative Value Unit benchmarks were obtained from data from the Medical Group Management Association, the American Medical Group Association, and McGladrey & Pullen

10. Trends in panel size January 2012 January 2013 January 2014 January
January 2012
January 2013
January 2014
January
2015
January 2016
Community
Panel size
72,681
75,012
78,261
82,632
84,687
Clinical FTE
51.83
45.77
41.96
44.9
41.7
Panel size per 1.0 FTE
1402
1639
1865
1840
2031
Residency
33,475
33,588
33,608
34,321
35,447
20.28
21.02
18.71
18.23
17.43
1650
1598
1796
1883
2034
a New compensation plan started January 2013, retroactive to July 2012
b This includes physician clinical FTE, not including resident, fellow and APP FTE. For faculty this number reflected both direct patient care and resident precepting.

11. Any predictions on what happened to office visits per panel member over time? How about non face to face patient encounters over time?

12. Residency clinics – Office visits and non face to face encounters
Slope= p<0.001
Non FTF encounters per panel
Avg 0.545
Avg 0.429
Slope= p=0.001
Avg 0.219
Avg 0.188
FM office visits per panel

13. Community clinics – Office visits and non Face to Face encounters
Slope= p<0.001
Non FTF encounters per panel
Avg 0.458
Avg 0.530
Avg 0.178
Slope= p<0.001
FM office visits per panel
Avg 0.136

14. Regional Clinics – Office visits and non face to face encounters
Slope= p=0.001
Non FTF encounters per panel
Avg 0.477
Avg 0.577
Slope= p=0.46
FM office visits per panel
Avg 0.141
Avg 0.155

15. Why is this important?
Implications for job descriptions and expectations for time spent in various activities for physicians and other care team members
Implications for staffing ratios for care team members such as MA, RN
Implications for appropriate panel size for physicians

16. More work to do… Comprehensiveness of care Patient satisfaction
Are we maintaining comprehensiveness or are we referring more things out to either urgent care or specialty care?
Patient satisfaction
Are patients happy to have more care over the phone and electronic messaging or are they feeling like they cannot get in when they need to?
Quality of care
Are we still able to give high quality care with fewer face to face visits?

17. Goal = Triple Aim

18. Many thanks!
Wen-Jan Tuan
Michelle Riley
Kathy McCain

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