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

Abstract

Work relative value unit (wRVU)–based fee schedules are predominantly used by both the Centers for Medicare & Medicaid Services (CMS) and private payers to determine the payments for physicians' clinical productivity. However, under the Affordable Care Act, CMS is transitioning into a value‐based payment structure that rewards patient‐oriented outcomes and cost savings. Moreover, in the context of solid organ transplantation, physicians and surgeons conduct many activities that are neither billable nor accounted for in the wRVU models. New compensation models for transplant professionals must (1) justify payments for nonbillable work related to transplant activity/procedures; (2) capture the entire academic, clinical, and relationship‐building work effort as part of RVU determination; and (3) move toward a value‐based compensation scheme that aligns the incentives for physicians, surgeons, transplant center, payers, and patients. In this review, we provide an example of redesigning RVUs to address these challenges in compensating transplant physicians and surgeons. We define 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 to include value‐based compensation.

National Early Career Transplant Hepatologist Survey: Compensation, Burnout, and Job Satisfaction

“…Recognition of individual nonclinical efforts is critical in assessing these individual programmatic contributions in transplant medicine and assigning these roles value. (4) Our survey results highlight several important observations regarding base compensation for early career transplant hepatologists. Average base compensation across all practice settings was US $305,496.…”

“…specificity for transplant hepatology and are reliant on traditional productivity metrics, limiting applicability to the subspecialty and failing to capture the full spectrum of clinical and nonclinical contributions of transplant hepatologists. (3)(4)(5)(6)(7)(8) In addition to uncertainty regarding compensation, another major issue facing new and junior physicians is burnout. Although rates of burnout among transplant physicians or surgeons have been rising, data on physician burnout specifically in practicing transplant hepatologists are not available.…”

The Perception and Impact of Relative Value Units (RVUs) and Quality-of-Care Compensation in Neurosurgery: A Literature Review

“…(5) RVU payment models in neurosurgery differ by institution and geographic region. (6) The burden of producing a higher quantity of RVUs has led to neurosurgeons relaying many of their routine responsibilities to other medical staff.…”

“…Giacoma et al designed and quantified a compensation model for transplant surgery that incorporated non-billable, value-generating work—dubbed customized RVU (cRVU)—into the existing RVU compensation model. The authors calculated cRVU for value-generating activities—such setting up satellite and virtual clinics for patients in need, improving quality and safety processes in their practice, coordinating patient care with other providers, and enrolling patients in research studies and clinical trials—into the existing RVU compensation model [ 6 ]. Similarly, authors representing a variety of medical specialties including radiology, vascular surgery, and gastroenterology have advocated for integration of desired outcomes such as quality of care, patient outcomes, patient satisfaction scores, teaching, and research into the existing RVU model [ 7 , 8 , 9 ].…”

Defining the roles and responsibilities of the kidney transplant medical director: A necessary step for future training, mentoring, and professional development

“…There is no standardized compensation model for transplant nephrologists 15 . Institutions that recognize the value of transplant nephrologists to the hospital are increasingly basing compensation in part on metrics important to the transplant center, which as a hospital‐based program, either compensates transplant nephrologists directly, or through academic departments via a funds flow mechanism.…”