Compensating the Transplant Professional: Time for a Model Change

Abstract

Compensation models for physicians are currently based primarily on the work relative value unit (wRVU) that rewards productivity by work volume. The value‐based payment structure soon to be ushered in by the Centers for Medicare and Medicaid Services rewards clinical quality and outcomes. This has prompted changes in wRVU value for certain services that will result in reduced payment for specialty procedures such as transplantation. To maintain a stable and competent workforce and achieve alignment between clinical activity, growth imperatives, and cost effectiveness, compensation of transplant physicians must evolve toward a matrix of measures beyond the procedure‐based activity. This personal viewpoint proposes a redesign of transplant physician compensation plans to include the “virtual RVU” to recognize and reward meaningful clinical integration defined as hospital–physician commitment to specified and measurable metrics for current non‐RVU‐producing activities. Transplantation has been a leader in public outcomes reporting and is well suited to meet the challenges ahead that can only be overcome with a tight collaboration and alignment between surgeons, other physicians, support staff, and their respective institution and leadership.

Transplant physician and surgeon compensation: A sample framework accounting for nonbillable and value-based work

“…Abouljoud et al propose recognizing and rewarding non-RVU generating activities through the use of "virtual RVUs." 6 Our proposed cRVU and OVU metrics are consistent with the concept of virtual RVUs but also promote the value-generating clinical effort. We offer a customized RVU (cRVU) for activities that typically do not generate wRVUs and create an outcome value unit (OVU) measure that incorporates outcomes and cost savings into RVUs based on value-based compensation.…”

“…Specific payment adjustments could be proportional to the impact of individual activities on outcomes or overall program success; hence, the per‐RVU conversion rate would reflect the value of the activity. Abouljoud et al propose recognizing and rewarding non‐RVU generating activities through the use of “virtual RVUs.”…”

“…Tables and show a detailed definition and rationale of cRVUs assigned to the nonbillable activities. Compensation for the cRVUs is based on the fair market value for median physician/surgeon salaries and CMS Medical/Surgical Director Reasonable Compensation Equivalent (RCE) …”

“…In the context of solid organ transplantation, with its unique relationship between institutions and physicians/surgeons, there are additional specific challenges . These include: (1) justifying payments for nonbillable work related to transplant activity/procedures (satellite clinic visits, organ placement coordination, organ recovery including dry‐runs, robotic surgery, and additional work burden such as patient portals, publications, and teaching sessions), (2) capturing the effort required of physicians/surgeons in support of the transplant center and infrastructure (academic, clinical, and relationship building) as part of RVU determination, and (3) contributing to regional and national transplant governing bodies . We believe sufficient data and experience already exist to address these challenges in solid organ transplantation and provide an institution‐based example of redesigning RVUs to quantitate better and compensate transplant services.…”

Workforce in hepatology: Update and a critical need for more information

“…Transplant hepatology is associated with significant nonbillable activities and downstream revenue; therefore, non‐RVU compensation models may be an alternative method to apply to compensation . Alternatives to wRVU‐based compensation models incorporate elements based on program growth (e.g., increasing transplant volume), waiting list additions, program building (outreach), program quality metrics (e.g., length of stay, posttransplant survival), or a combination of these elements.…”