Hospitalist Productivity
Although hospitalists are earning more, the 2011 report also shows they are producing more work relative-value units (wRVUs) than ever before. The median physician wRVU rate annually for 2011 was 4,166, a 1.4% increase over the 2010 figure.
Hospitalists in the Eastern and Midwest regions reported relatively unchanged wRVUs when compared with 2010 figures. The Southern region, which outdistanced the other regions by more than 800 wRVUs per physician, reported a 6.7% decrease in wRVUs—4,931 in 2011 compared with 5,287 in 2010. On the flipside, the Western region showed a 11.9% increase per physician (see Table 2, left).
PAC committee members agree the wRVU variance between regions is difficult to explain, but most agree the slight year-over-year increase in productivity shows the specialty is stabilizing in terms of what productivity is expected from the average hospitalist.
“Maybe it is an indication that the field is maturing and we’re settling in at some data points that we can now potentially put some stock into,” says Beth E. Hawley, MBA, FACHE, senior vice president of The Cogent Group, a consulting division of Brentwood, Tenn.-based Cogent HMG. “Before, [the figures] changed dramatically from survey to survey; I think we’re seeing more stability now from last year to this year.
It’s helpful to be able to sort [wRVUs] by employment model, by region, by large and small hospital. We can really get some better benchmarks in terms of what should be the expectation.
—Beth E. Hawley, MBA, FACHE, senior vice president, The Cogent Group, Brentwood, Tenn., SHM Practice Analysis Committee member
“It’s helpful to be able to sort [wRVUs] by employment model, by region, by large and small hospital. We can really get some better benchmarks, in terms of what should be the expectation.”
Chris Frost, MD, FHM, national medical director of hospital medicine services for HCA, says he remains somewhat hesitant to say HM is “settling into a number” for expected wRVUs, as he routinely hears from hospital administrators looking for “additional efficiencies that we can put in place to allow and position the hospitalists to be more productive” while maintaining a high quality care delivery model. He’s also puzzled by the geographic discrepancies. “I just have to scratch my head. I haven’t entirely figured that out yet,” he says.
That said, Dr. Frost agrees the wRVU benchmarks are the most useful in terms of “billable productivity. But I also would like to see—or believe—one of the reasons compensation is going up and the work RVU is flat is hospitalists are being recognized for their value in other arenas, as it relates to the transition from the fee-for-service to pay-for-value-type models, championing effective transitions of care, leading process improvement teams, etc. Those things can’t, or don’t, necessarily lend themselves well to a work RVU equivalent.”
The Buzz: Financial Support
First reported at HM11 in May, the survey shows hospitalist support payments increased more than 39%, to $136,403 per FTE hospitalist in 2011 from $98,253 in 2010. PAC members and other hospitalist experts in practice management attribute the startling increase in support payments to more accurate reporting. Others note that the rise in support payments could be attributed to the decline in collection of professional fees, a direct result of the economic downturn.
And, according to Dr. Landis, hospitals are more willing today to fund hospitalist services than ever before.
“I think [the rise in HM support] payments is because of the evolution of healthcare in the hospital as a whole,” he says. “Hospitals are looking to hospitalists to help them provide the care that that patients and families need, expect, and want. And we’re stepping up to the plate to do it, and they’re paying us to do it. I think that’s the story.