INFOGRAPHIC | Advanced Practice Provider Productivity
How do health care organizations select which APP productivity metrics to measure?
As health care organizations look for ways to better utilize and retain their clinical workforce, effectively measuring and projecting advanced practice provider productivity is imperative.
SullivanCotter’s 2021 Advanced Practice Provider Compensation and Productivity Survey reports productivity data and ratios, collections, and work RVUs from 210 participating organizations – including independent hospitals, health systems, academic medical centers and more. The survey also reports COVID-19-adjusted work RVUs to help organizations better understand the impact of the pandemic.
The 2022 survey is now open! Submit data to gain access to exclusive participant benefits.
Looking to gain additional insight?
Learn more about developing effective productivity measures and rewards to help support your growing APP workforce.
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E-Book | Key Agenda Items for Health Care Board Committees
Supporting health care board committee effectiveness in a changing environment
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SullivanCotter has contributed two chapters to the third edition of the comprehensive e-book from McDermott Will & Emery entitled Key Agenda Items for Board Committees: Supporting Committee Effectiveness in a Changing Environment.
> Trends and Priorities for the Human Capital Committee
Authors: Tim Cotter, Managing Director - Kathy Hastings, Executive Workforce Practice Leader - Cathy Loose, Employee Workforce Practice Leader
Is your organization equipped to address ongoing industry challenges in 2022 and beyond? COVID-19 has not only accelerated dramatic shifts within health care, it also has become a catalyst for change in workforce strategies. Identifying emerging trends and practices and understanding their impact is important for the human capital committee to consider as it plans for the upcoming year.
> 10 Questions for the Compensation Committee
Authors: Tim Cotter, Managing Director - Bruce Greenblatt, Managing Principal
What important items should the Compensation Committee be considering as it plans for 2022 and beyond? SullivanCotter addresses important committee priorities, compensation-related matters such as executive salary adjustments and incentive programs, critical diversity, equity and inclusion initiatives, and more.
INFOGRAPHIC | 2021 Advanced Practice Provider Compensation and Productivity Survey
Market-leading survey data to help manage the growing APP workforce
As health care organizations nationwide continue to increase the size of their advanced practice provider workforce, the market’s interest in data-driven intelligence to help recruit, retain, and engage this critical provider group is growing.
View highlights from SullivanCotter’s 2021 APP Compensation and Productivity Survey – featuring data on more than 92,000 thousand individual APPs (nurse practitioners, physician assistants, certified registered nurse anesthetists, certified anesthesiologist assistants and certified nurse midwives) and nearly 2,200 APP leaders.
The survey collects and reports important advanced practice provider benchmarking information as it relates to utilization, productivity, compensation, pay practices as well as addressing important issues such as APP turnover and vacancy rates. Additionally, this year’s results contain the first set of benchmark data following the onset of COVID-19 and represent an important resource for organizations needing pre and post-pandemic reference points.
The 2022 survey is now open! Submit data to gain access to exclusive participant benefits.
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PRESS RELEASE | Aimee Greeter Joins Physician Workforce Practice
Leading pay and career equity initiatives with organizations looking to improve fairness, transparency and advancement
Chicago, IL | January 25, 2022
SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce the addition of Aimee Greeter, Principal, to the firm’s growing Physician Workforce Practice.
For nearly 15 years, Aimee has served as a trusted advisor to a variety of health care provider organizations nationwide. As the industry continues to undergo significant change, Aimee works with physician groups and health systems of all sizes to develop competitive compensation and rewards strategies focused on supporting pay equity and enhancing physician engagement.
“In the wake of a COVID-19 resurgence, recent changes to the Physician Fee Schedule, and a looming provider shortage, hospitals and health systems are dealing with a myriad of challenging present-day obstacles,” said Mark Ryberg, Physician Workforce Practice Leader, SullivanCotter. “Aimee’s deep-seated industry knowledge and strategic insight reinforces our ability to provide clients with the guidance needed to develop innovative solutions to complex issues as they plan for 2022 and beyond.”
Aimee specializes in helping organizations assess, develop and implement pay and career equity initiatives and consults with employers on ways to improve fairness, transparency and advancement for all people regardless of their gender identity, race and ethnic background. She also works closely with clients to optimize physician and advanced practice provider alignment and affiliation activities to support quality care outcomes, cost efficiencies, integrated care team delivery and patient-centered operations.
Aimee has additional experience in conducting clinical service line reviews, providing advisory support on mergers and acquisitions, and facilitating boards and executive leaders in strategic planning and growth initiatives related to market sustainability, care delivery transformation and business model evolution.
Before joining SullivanCotter, Aimee held senior leadership roles at a boutique health care consulting group.
Aimee is the author of the recently published book Effective Crisis Leadership in Healthcare: Lessons Learned from a Pandemic and is a popular national speaker on topics of crisis leadership, health care transactions and provider engagement. She is also a Fellow in the American College of Healthcare Executives and holds a Lean Six Sigma Yellow Belt.
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APPs: 2021 Evaluation and Management CPT Codes
Part II: Understanding the Impact on Advanced Practice Providers
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PART I | 2021 E&M CPT Code Changes: Understanding the Impact on Physician Compensation
INFOGRAPHIC | Considerations for Addressing the 2021 E&M Work RVU Changes
ARTICLE | Navigating Change: Implications of the 2021 Physician Fee Schedule
SullivanCotter's CPT Advisory Services and Technology Solutions
BACKGROUND
Every year, the Centers for Medicare and Medicaid Services (CMS) evaluates the recommendations of the American Medical Association’s Relative Value System Update Committee and conducts its own review of the Work Relative Value Unit (wRVU) values associated with each Current Procedural Terminology (CPT) code to determine if revisions are needed based on the time, skill, training and intensity necessary to perform each service. The degree of change varies from year to year, and the impact on individual specialties depends on which codes are modified and the extent to which the codes are adjusted.
CURRENT SITUATION
At the end of 2019, CMS proposed widespread modifications to a subset of the Evaluation and Management (E&M) CPT codes (99201-99215) that include face-to-face office visits and other outpatient services for new or established patients. The goal of the adjustments is to provide an increase in certain wRVU values to address added responsibilities clinicians have absorbed over the last five years, reduce documentation requirements, recognize extended patient visits, and account for qualified, severe or complex chronic conditions. On December 1, 2020, CMS finalized the 2021 Physician Fee Schedule – which went into effect on January 1, 2021.
Additionally, in response to COVID-19, CMS has implemented new guidance as it relates to telehealth services. Although it is unknown whether these CPT code changes will be maintained or altered as the pandemic subsides, the agency has indicated a desire to make longstanding revisions to telehealth visit valuations. While the 2021 Physician Fee Schedule final rule permanently expanded some of the telehealth changes for rural communities, the adoption of the telehealth changes has not been identified as permanent.
In Part I of this series, SullivanCotter explored the impact of the E&M code changes on physician compensation and productivity levels as well as other implications health care organizations must be mindful of as they plan physician compensation for 2021 and beyond. For additional background, Part I also included a detailed summary of the final changes – including greater insight into the “Patients Over Paperwork” goal, the results of a work-effort/time-study commissioned by CMS, and two related add-on codes.
As we continue to assess how these changes affect the clinical workforce, Part II in this series reviews the impact on advanced practice providers (APPs).
ADDRESSING THE IMPACT ON ADVANCED PRACTICE PROVIDERS
Based on the overlapping scope of services performed by APPs and physicians, CMS modifications to CPT code valuations will impact both APPs and physicians. At a broad level, these changes include:
- An increase in wRVUs for most office-visit E&M CPT codes due to added responsibilities clinicians have absorbed over the last five years.
- A 3.3% reduction in the Medicare conversion factor (now $34.89) for physician fee schedule payments to maintain budget neutrality that impacts all E&M services no matter who provided the service.
- An add-on code to recognize extended office-visit time.
Due to the differences in practice patterns between APPs and physicians, there will be some variation in how the changes will impact APPs as compared to physicians. The differences may include the following factors:
- APPs often perform a greater amount of non-billable work and provide services covered under a global visit.
- APPs may see lower acuity patients in some specialties or settings.
- In our analysis of reported CPT data, APPs in surgical specialties report E&M services (e.g. office visits) as a greater proportion of their overall work compared with physicians who report a relatively greater proportion of procedures and surgeries.
Additionally, there are some APP-specific provisions that may affect scope of practice:
- Effective as of January 1, 2021, Medicare now permits physician assistants (PAs) to perform diagnostic tests in accordance with supervisory requirements outlined in state law rather than in Medicare’s general supervision requirements. This change means that PAs are no longer subject to two sets of requirements as Medicare now defers to state policy instead. This helps to reduce administrative burden and potential confusion within organizations about which regulations to follow.1
- The rule for 2021 allows all APPs (APRNs and PAs) to supervise the performance of diagnostic tests in accordance with their state’s scope of practice. Previously, only physicians were authorized to do so. The ability of APPs to be able to perform diagnostic tests will likely have an impact on APP procedural specialties like interventional radiology and some medical specialties such as cardiology and gastroenterology.2
As health care organizations absorb these changes and plan for what lies ahead, there are a number of practical implications for APP productivity and compensation to keep in mind. This article helps organizations to understand and address the impact on APP productivity levels in various specialties, temporary changes to telehealth codes, and unintended consequences for APP productivity-based incentive plans. It also highlights other variables that could influence the assessment of APP productivity – such as survey benchmarks and how to utilize these going forward.
WORK RVU ADJUSTMENTS
The impact of the wRVU changes may result in material shifts in wRVU productivity for APPs. According to SullivanCotter’s 2020 Advanced Practice Provider Compensation and Pay Practices Survey, over 40% of APPs work in office-based specialties and ambulatory clinics.
Table 1 below compares the pre-2021 E&M code time allocation and wRVUs to the January 2021 changes.
Note that the established office-visit codes 99212-99215, which are the most frequently used office-visit codes, show the most significant increases between 28%-46%. To balance CMS’ expenditures, the 2021 conversion factor, which is multiplied by total RVUs to determine Medicare payments to physicians and APPs, has dropped by 3.3% from $36.09 to $34.89. SullivanCotter notes that approximately half of the rate reduction mitigation is designated only for the 2021 calendar year as a result of the Consolidated Appropriations Act of 2021 – meaning an additional conversion factor reduction looms for 2022.
This change impacts all clinicians regardless of specialty and, combined with the E&M wRVU increases, creates a redistribution of federal payer reimbursement from proceduralists and hospital-based specialties to cognitive specialties.
Table 1: Time Allocations and wRVUs Adjustments: Current Versus 2021
Additionally, there are CPT code changes related to COVID-19 that will impact both physician and APP compensation and productivity. In March 2020, CMS expanded the Medicare telehealth coverage waiver to enable beneficiaries to receive a wider range of health care services from clinicians without having to travel to a health care facility. The announcement expanded previous telehealth coverage for beneficiaries living in rural areas who were able to receive care at a local facility with a clinician from a remote area.3
Under the new provisions, all beneficiaries are able to receive telehealth coverage. Effective March 2020, telehealth services were paid under the Medicare Physician Fee Schedule at the same rate as in-person services.
Table 2 below compares the pre-COVID-19 E&M code time allocation and wRVUs to the changes made in March 2020. It is unclear how long CMS plans to keep the expanded rates in place.
Table 2: Telehealth wRVU Adjustments: Results of 2020 Waivers
THREE IMPORTANT POTENTIAL IMPACTS TO APP PRODUCTIVITY LEVELS AND RESULTING COMPENSATION AND BENCHMARK MEASUREMENTS
1. How will the 2021 wRVU changes impact the measurement of APP productivity?
This common question is complex for APPs given that productivity benchmarks have generally been difficult to collect and interpret due to the wide variation in how APPs are utilized – even within the same specialty. Historically, productivity data has been absent, inconsistent or inaccessible due to the variety of billing practices used to capture APP work effort including shared visits and incident-to billing. Additionally, APPs often perform more non-revenue generating work compared to physicians in the same specialty (e.g., global visits) – contributing to inconsistency and difficulty in collecting the data.
To help analyze the impact, SullivanCotter used its proprietary database consisting of individual CPT code volumes and modifiers for approximately 3,000 APPs across 45 different specialties. Two sets of wRVU productivity benchmarks were calculated for comparison. One is based on the pre-2021 wRVU values, and one is based on the 2021 wRVU values. By keeping volumes and distribution consistent, the resulting change in wRVU productivity is due entirely to the E&M wRVU adjustments.
Summary findings indicate that of the 45 specialties reviewed, the average change for all specialties due to the E&M adjustments is 14.6%. As shown in Table 3 below, nearly half (44.4%) of wRVU benchmarks increased between 6% and 17%. An additional 44.4% of specialties were impacted by changes greater than 17%. Only two specialties had changes of less than 1%.
Table 3: Overall APP Specialty Impact of 2021 E&M Changes
Table 4 below shows a representative sample of the resulting impact at the specialty level. This represents a significant change to wRVU benchmarks in many specialties and will be important for organizations to understand the implications to APP compensation payouts and affordability in all of the various specialties and care teams. Comparing the estimated wRVU changes for APPs and physicians in the same specialty shows general alignment in the medical and primary care specialties with a greater impact on the APPs in surgical specialties due to the higher utilization of E&M visits by APPs compared to physicians.4
Table 4: Median wRVU Impact of 2021 E&M wRVU Changes
2. How will wRVU changes impact compensation for APPs differently than physicians?
The impact will vary for a few notable reasons.
According to SullivanCotter’s 2020 Advanced Practice Provider Compensation and Pay Practices Survey, only 56% of organizations use wRVU data to adjust APP compensation as compared to greater than 90% for physicians.5,6 Because APP compensation is typically salary-based, APPs are less susceptible to compensation impacts due to the CPT adjustments.
Additionally, nearly half of APPs with an incentive component in their compensation plan have the productivity-based incentive amount capped – which will affect the degree to which compensation will be impacted.5
Finally, in our experience, the market compensation per wRVU rate for APPs is often utilized in a different manner compared with physicians. Physician compensation plans typically directly utilize the market compensation per wRVU benchmark rate as a major incentive to drive compensation. For APPs, whose compensation plans are not as heavily incentivized as physician plans, organizations often just utilize market wRVUs and/or compensation per wRVU rates as a guide. Typically, APP plans allow for more significant guaranteed base salaries. Depending on the methodology used for each, this may limit the impact of any increases in APP compensation due to the changes.
Table 5 below highlights the estimated changes to survey benchmarks. See Column A to find the estimated change in compensation.
Table 5: Estimated Survey Benchmark Changes in Clinical Compensation and wRVUs
If an organization utilizes data on wRVU productivity targets to determine compensation using the pre-2021 survey data while calculating wRVUs using the 2021 wRVU schedule, this will result in higher payouts as APPs on incentive plans will meet or exceed the benchmarks at a much greater rate.
Similarly, if an organization uses the pre-2021 compensation per wRVU survey benchmarks while using the new 2021 values to calculate APP productivity, clinical compensation will increase as a result of the pre-adjusted compensation per wRVU rates.
These compensation change estimates are based only on the recalculations of the E&M wRVUs. This does not estimate other market factors that also drive compensation change. Additional factors include supply and demand, inflation, cost-of-living, changes in productivity and more. As with wRVUs, these factors can also vary significantly by specialty.
3. How will this impact APP compensation?
This depends on the structure of an organization’s existing APP compensation program and the degree of productivity incentive. It may have less of an impact than changes to physician compensation for a number of reasons:
- As noted previously, just over half (56%) of organizations use market wRVU data to adjust APP compensation.5
- Only 35% of organizations reported wRVUs for all APPs within the organization.5
- 42% are not tracking or reporting APP wRVUs at all.5
- 49% of organizations report having incentive plans for APPs with wRVUs being the most common component.5
Organizations incentivizing APPs based on wRVU productivity and utilizing national benchmarks to determine annual salaries and compensation per wRVU rates need to assess and understand how these changes to the benchmarks will impact APP compensation payout levels.
SullivanCotter reviewed several different compensation methodologies to estimate the impact on survey benchmarks. Considering the E&M code changes and assuming no modifications are made to compensation plan methodologies, we estimate the average clinical compensation for all APPs to increase by approximately 0.5%. This is compared to approximately 6% for physician compensation identified in Part I.
For organizations with APPs whose pay is structured more like physician compensation, it will be critical to understand the impact these changes will have on incentive plans – which is likely to be far greater than the average 0.5% suggested in this study.
4. If organizations utilize compensation per wRVU benchmarks for APPs, what should they expect with regard to the 2021 benchmarks?
For any group implementing the 2021 rate into their APP compensation plans, a fundamental understanding of how market benchmarks will change is important. This is especially true in some of the procedural specialties where APPs code a much higher number of E&M visits (compared to physicians who are more focused on the procedural codes). As a result, APPs will often see marked increases in wRVUs. It is important to monitor the unintentional impact on work effort for both APPs and physicians as clinicians adapt to the new weighting of professional encounters.
OTHER FACTORS TO CONSIDER WHEN ANALYZING COMPENSATION IMPACTS
As organizations continue to evaluate the impact of the 2021 Physician Fee Schedule, there are several additional factors to consider. These include:
- Are physician and APP compensation plans, incentive opportunities, and metrics aligned and will changes to one component impact the other?
- For specialties that include paid shift rates, are there additional incentives based on productivity?
- Does the organization pay physicians and APPs for virtual care visits that tie to E&M values? This could result in higher compensation for virtual care.
- Will the changes in CPT valuation for telemedicine be permanent or be adjusted after the end of the pandemic?
- CMS will also be adding G2212 as an add-on code for every 15 additional minutes of visit time. The assumptions and analysis above do not account for the changes in the distribution of E&M coding or increases in wRVUs due to these new codes.
- A wRVU increase does not automatically equate to an equal revenue reimbursement increase.
- CMS also applies an annual budget factor that caps the overall per wRVU reimbursement to avoid a significant increase in CMS payments. This can significantly increase the total percentage of revenue an organization receives that can be paid to physicians and APPs.
Sources:
1CMS Releases 2021 Physician Fee Schedule Rule. AAPA News Central. December 2, 2020. Accessed at: https://www.aapa.org/news-
central/2020/12/cms-releases-2021-physician-fee-schedule-rule/
2Proposed Policy, Payment and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021. August 3, 2020. Centers for Medicare and Medicaid Services. Accessed at: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4
3Medicare Telemedicine Health Care Provider Fact Sheet. Centers for Medicare and Medicaid Services Fact Sheet. March 17, 2020. https://www. cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
4SullivanCotter Large Clinic® CPT Benchmark Study
5SullivanCotter 2020 Advanced Practice Provider Compensation and Productivity Survey
6SullivanCotter 2020 Physician Compensation and Productivity Survey
SullivanCotter offers advisory support and technology solutions to help your organization understand and respond to the potential impact of these changes.
To learn more, contact us at 888.739.7039 or info@sullivancotter.com
Q&A | Utilizing Technology to Engage the Clinical Workforce
Aligning clinical workforce compensation strategies with quality and efficiency goals
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Health care continues to evolve at a rapid pace as the industry seeks to maintain financial sustainability and transform operations in the midst of post-COVID-19 recovery plans. This includes enhancing the quality of care, managing costs, improving patient access and satisfaction, and increasing physician and staff engagement to help achieve organizational goals. Market pressures are forcing organizations to develop new clinical capabilities as well as adapt their operations to perform more effectively under value-based reimbursement requirements. A key success factor in this evolution is the ability to align quality and efficiency goals with physician and advanced practice provider (APP) compensation strategies.
As pay practices continue to evolve, many organizations are looking to address the following questions:
- How can you ensure your compensation administration and performance management programs are engaging physicians and APPs in support of your cultural and organizational strategy?
- What tools and resources will help to enhance transparency in the reporting of performance to clinicians?
- What are the optimal communication, education and engagement processes to align performance around value-based metrics?
- How do these tools and resources help with recruitment and retention of the clinical workforce?
Compensation and performance management tools require transparency to build trust and reliability while also enhancing the clinical workforce’s ability to understand the process and the results.
Consistent measures, reporting, and expectations are foundational to building trust.
SullivanCotter consultants Kevin Wilson, Dan Iliff and Tom Trachtman recently answered questions on aligning physician and APP workforce performance — helping to uncover emerging trends, technologies and practices among high-performing hospitals, health systems and medical groups.
Why should health care organizations prioritize their compensation and performance programs during this transition?
DAN: Whether your organization is a single specialty independent medical group or one of the largest health systems in the country, success is reliant on the performance of your clinical workforce. As with any employee, in any industry, compensation and work expectations are two important variables. When appropriately designed and aligned, compensation plans play a vital role in helping to motivate this workforce and achieve organizational objectives. These variables are also important in clinical staff satisfaction and retention.
Physicians and APPs often express dissatisfaction when they do not fully understand their compensation plans, lack insight into how they are being measured, or do not have faith in the reporting system. This is becoming more common with the increasing prevalence of value-based pay components. This lack of transparency can leave them feeling disengaged and may contribute to turnover.
KEVIN: Agreed, Dan makes an important point. An effective compensation strategy is critical to engage and align the clinical workforce to achieve targeted performance. The importance of alignment is growing in the
transition to value-based care as organizations integrate more non-productivity metrics into compensation plans to help improve access, quality of care, service and affordability. Historically, physicians and APPs have lacked faith in the accuracy of reported non-productivity metrics. In order to reach desired outcomes and results, the administration, management and reporting process must be comprehensive and transparent enough to truly engage physicians and APPs. Regardless of the size or scope of your operations, a more transparent view into how physicians and APPs are performing and being paid is critical. This requires access to timely, accurate and actionable data in an understandable format. A comprehensive performance management program and process supported by innovative technology and reporting can help to achieve this.
What are some of the common administrative pain points hospitals, health systems and medical groups are experiencing as they try to support the engagement and alignment of a growing population of physicians and APPs within their organizations?
DAN: The way in which organizations measure and report physician and APP performance is often outdated and opaque. With a change in both the number and type of performance metrics being used, all of which help reflect a more balanced approach to performance, compensation programs are becoming increasingly complex and difficult to administer. Physicians and APPs often find the data difficult to understand, hard to verify and lacking in transparency. For these reasons, many organizations are struggling to effectively engage their clinicians in new pay-for-performance models that now include value-based metrics in addition to traditional productivity components.
According to SullivanCotter’s 2020 Physician Compensation and Productivity Survey, the prevalence of value/ quality incentives as a compensation plan component, which rewards performance on measures such as clinical quality, patient experience and access, hovers at or above 50% for all major specialty categories — primary care, medical, surgical and hospital-based. While reimbursement models continue to evolve and organizations are focused on incorporating more complex value-based components into their compensation programs, many organizations lack the internal processes and systems to efficiently track and manage multiple areas of performance. With multiple sources of information, this process can be both tedious and time-consuming, especially given the limited number of personnel assigned to the task.
Today, organizations often track performance relative to these new quality metrics in large and unwieldy offline spreadsheets. Not only do these spreadsheets create problems with version control, but error rates tend to increase as teams manually sift through endless rows of data. With nearly 90% of spreadsheets containing mistakes, this can prove costly as these errors can have a large impact on critical compensation and reporting functions.1 Additionally, there are the added complexities of data capture and validation across an increasing number of physicians, APPs and their associated sub-specialties. This complexity adds to the distrust that physicians and APPs often experience with these types of measures.
TOM: One of the most common issues I’ve seen related to this is delayed and incomplete production figures that lead to inaccurate performance results. Poor reporting makes it difficult for physicians and APPs to both track and trust what is being reported. Additionally, it makes it difficult for leadership to assess progress toward organizational goals. The lack of transparency doesn’t help to instill trust in the data. A large quantity of performance and productivity data must be properly merged, analyzed and validated from disparate systems before physicians, APPs, clinical leaders and managers can obtain and act upon the information they need. These limited reporting capabilities are a burden on the administrative staff responsible for delivering the information and helping to provide actionable insights.
Moreover, many organizations cite a lack of analytical talent available to properly evaluate the data they already have – and the COVID-19 pandemic may further this shortage. A recent report conducted by the Everest Group states that “75% of enterprises believe there will be a talent shortage for key roles in IT, analytics and special skills areas post-COVID-19…new skills gaps will emerge as a result of the structural changes in business occurring in response to the pandemic.”2 As health systems merge, consolidate and increase the number of physicians and APPs within the organization, the amount of data will only become more difficult to manage. Similarly, there must be control mechanisms in place to govern the data and ensure it maintains validity and relevance.
How can organizations develop a trusted performance management program that addresses and aligns a spectrum of needs for all key stakeholders — including leadership, physicians, APPs and administrative staff?
KEVIN: Clinical delivery structures are evolving and there should be a comprehensive process in place to administer, analyze and report on physician and APP performance and compensation across various levels of leadership. The first step is to consider the needs of each group of stakeholders:
Leadership
- Routine and consistent reporting with easy-to-consume information to assess progress towards organizational goals
- Actionable insights into drivers of performance at the organization, group and physician level
- Ability and capacity to focus on performance improvement efforts and coaching
Administration
- Accuracy, speed and reliability of performance and compensation analytics
- Alignment with internal partners
- Capacity and tools for deeper analysis
- Identification and reconciliation of issues
- Efficient utilization of technology to analyze real-time data to provide insight to leadership
Physicians and APPs
- A trusted and reliable source of truth for timely and efficient clinical compensation and performance management
- Easily accessible, current-state, performance results with clear action steps to help drive improvement
- Access to individual, peer and group performance in addition to patient-level detail
- Supporting resources (people, processes, technology) that enable physicians and APPs to make changes that can help improve results
How can technology be used to enable and provide greater value for your organization?
KEVIN: Alignment is important to building a trusted and reliable compensation and performance management program that engages clinicians. Along with the clinical workforce, leadership and administrators also require a clear understanding of expectations, progress and results. Without the ability to provide these insights in a timely fashion, these stakeholders are unable to effectively understand key drivers of performance and assess progress against goals. Building trust through transparency is key, and it leads to higher engagement, enhanced collaboration and clearer lines of communication. The expected outcomes should be clinically significant as well as easy to understand and measure.
With the addition of new quality incentives, a greater degree of “at-risk” compensation has become commonplace for physicians and APPs. Whether this “at-risk” compensation is based on panel size, access, clinical quality metrics or patient satisfaction, it is becoming common to have a component of compensation tied to performance. For primary care physicians, median quality incentive payments comprised 7.4% of total cash compensation in 2020.3 For medical and surgical specialists, this percentage is lower at 5.6% — although we expect to see growth as organizations work to further develop and refine these programs to ensure they have credible measurement and reporting systems in place before moving forward.3
DAN: I agree. High-performing organizations are constantly evolving and must be supported with tools and technology that can evolve with them. Technology is a platform for change at a time when change is inevitable. By providing access to clear and concise performance data all in one place, technology can serve as a single source of truth that combines administration, reporting and analytics capabilities into one system. The right technology can turn data into actionable insights, communicate goal definitions, benchmark performance, develop KPI reports and automate a number of data-related functions — all of which help to build trust and instill greater confidence in the data and reported results. Greater transparency can also play a critical role in improving engagement and aligning physicians and APPs with the mission and vision of the organization in which they work. Moreover, technology will enable physician leaders to better focus their efforts where it really counts — actively managing and coaching the clinical workforce.
What are the most important things to consider when assessing how technology can better support your performance management and compliance program?
DAN: New tools and technologies can allow your organization to streamline an increasingly complex communication, compensation and performance process by resolving inefficiencies in the way that data is collected, analyzed and reported. When assessing how technology can support these changes in relation to physician and APP compensation, performance and compliance, there are four key areas of functionality to consider:
- Performance management
- Productivity insights
- Compensation administration
- Contract lifecycle management
The first key area of functionality is performance management. Organizations must have a comprehensive system in place to communicate, measure, and drive performance while delivering actionable insights.
Once the key drivers of performance are identified, this understanding can then be translated into action and ultimately lead to improved results. Organizations must also provide the tools and support to help physicians and APPs improve performance while being mindful of not adding undue complexity or setting unrealistic expectations.
TOM: For example, imagine a scenario where physicians and APPs are compensated based on patient access. There has to be visibility into their schedules, time to next appointment, patient wait times and other components related to this metric. Without this visibility, there are limited fact-based insights to be gained.
The ability to properly assess performance and related compensation against defined targets and metrics is important to identifying best practices and improvement opportunities. Extensive built-in audit and reconciliation tools that help to ensure data integrity and improve the speed and accuracy of administration efforts exist in the marketplace today and can provide customized access and views tailored to the unique needs of leadership, physicians and administrators.
DAN: Another key piece of functionality relates to productivity insights. As a result of constantly changing wRVU schedules, evolving compensation models, billing reconciliation and other changes, physician and APP compensation and performance administration is multifaceted. Technology that automates the revenue and productivity data collection and analysis component of this process will yield immediate time savings for physicians, APPs and administrators. Additionally, it will allow physicians and APPs to be able to understand the reported data and have faith in the process. A system that allows you to review billing information in a central repository and assists with complex RVU functions such as sharing arrangements, scale conversion, modifier adjustments and non-billable credit information will greatly increase the speed and accuracy of a multitude of productivity assessments. The consistency and transparency of the process will also build trust with the physicians and APPs and ultimately creates time and credibility for your team to dedicate to more strategic initiatives.
The third area of focus is on compensation administration — or the communication of results. This is where a compensation program comes full circle through customized dashboards and reports that are tailored to
individual providers and administrators. By integrating data on compensation earned from all sources for all physicians and APPs in a central repository, technology will help streamline the reporting process and get the right data into the right hands at the right time. The timely delivery of accurate compensation results to the clinician strengthens trust and improves engagement. Whether you are an administrator facilitating monthly settlements or a physician or APP monitoring performance on specific metrics, these dashboards are the key to success and will help to track progress against organization-wide goals.
Lastly, ensuring that physician employment agreements align with system-wide compensation terms and payments remains a challenge for health care organizations nationwide. Integrating an automated contract
lifecycle management solution that will provide your organization with an accurate and comprehensive view of clinical employment contracts and obligations across the organization in real-time helps to support compliance and ease of administration while also providing transparency and greater access to the clinicians.
The ideal technology solution brings all four of these components together to equip your organization with a more transparent, accurate and timely view of individual, group and system performance. physicians and leadership with the information they need to reliably inform performance and drive desired outcomes. A strong technology platform can act as the cornerstone to help facilitate change. Similar to how EHRs revolutionized care delivery, a mature compensation and performance infrastructure can help to revolutionize how performance is measured and communicated.
What are the next steps for organizations considering the implementation of a new compensation and performance management system?
TOM: Compensation and performance programs are constantly evolving in today’s dynamic health care marketplace and organizations will continue to adapt as operations grow more complex. They require scalable solutions to help streamline the compensation administration process while also providing physicians and leadership with the information they need to reliably inform performance and drive desired outcomes. A strong technology platform can act as the cornerstone to help facilitate change. Similar to how EHRs revolutionized care delivery, a mature compensation and performance infrastructure can help to revolutionize how performance is measured and communicated.
DAN: The specific actions your team should consider include:
- Identify key stakeholders through a holistic analysis of your compensation and performance program
- Aggregate and organize pain points across stakeholders to identify their root cause
- Acknowledge gaps in technology in order to meet the needs of all stakeholders
- Determine the functionality required to assess, analyze and report on physician and APP performance
- Evaluate the technology options available and how respective platforms can help advance your organization’s performance management programs
SullivanCotter’s Provider Performance Management Technology™
Provider Performance Management Technology™ (PPMT™) is an industry-first, cloud-based solution that enables clinician engagement through transparent performance-based compensation administration, contract management, and reporting and analytical capabilities.
Utilizing best-in-class technology and decades of physician compensation and health care expertise, PPMT™ is designed to support organizations in the transition from volume to value. PPMT™ is offered as part of a comprehensive portfolio of advisory, information and technology services to address client needs.
As a trusted partner in compensation and performance management, reach out to SullivanCotter to learn more about our comprehensive Provider Performance Management Technology™ and our suite of clinical workforce advisory services.
Sources:
- 1Olshan, Jeremy. (2013). 88% of Spreadsheets Have Errors. MarketWatch. Retrieved from https://www.marketwatch.com/story/88-of-spreadsheets-have-errors-2013-04-17
- 2The Everest Group. (2020). 75% of Enterprises Bracing for Widening IT & Analytics Talent Shortage Despite Recession. Retrieved from https://www.everestgrp.
com/2020-08-75-of-enterprises-bracing-for-widening-it-analytics-talent-shortage-despite-recession-press-release-.htmlhttps://hitconsultant.net/2019/10/16/health-it-staffing-shortage-crisis/#.YGtEaehKiUk - 3SullivanCotter 2020 Physician Compensation and Productivity Survey Report
Modern Healthcare | Physician Compensation Plateaus During Pandemic
Protecting physician compensation during the COVID-19 pandemic
While many health care organizations continue to undergo post-pandemic financial and operational recovery planning, maintaining the broader workforce remains a top priority. Although physician compensation may have been expected to drop over the course of the last year due to a major decline in patient volumes and the cancellation of elective procedures during the shutdown, the majority of hospitals and health systems implemented to protect physician compensation to some degree.
Featured in a July 2021 edition of Modern Healthcare, SullivanCotter helps to evaluate how compensation evolved during the COVID-19 pandemic, which pay actions organizations implemented in response, and how to move forward with evaluating pay programs for 2021 and beyond. Organizations will now need reassess physician pay models in light of recent events to help maintain operations and support future sustainability while paying close attention to newly-released 2021 benchmarks and effectively adjusting for months most affected by the pandemic.
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Clinical Workforce Technology Solutions | Webinar Series
To help health care organizations address increasingly dynamic clinical workforce requirements, SullivanCotter continues to strengthen our innovative suite of technology, survey and data products.
Join us as we feature some of our newest product enhancements and demonstrate how you can leverage data-driven insights to identify physician market demand, interactively analyze workforce benchmarks, administer compensation and performance management programs, and automate the physician contract lifecycle to better support your care team and population health initiatives.
As we continue to refine our product roadmap, we’d love the opportunity to hear your feedback on various features and functionality, proposed enhancements, and key clinical workforce challenges that your organization is facing.
Session 1: Benchmarks360™
Tuesday, July 27 | 12:00pm-12:45pm CT
Powered by SullivanCotter’s proprietary survey data and research, Benchmarks360™ is a suite of intelligent, web-based products that enables health care organizations to analyze and visualize compensation, clinical productivity, and workforce perceptions.
What's New?
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- Complimentary access to survey participants
- APP Utilization and Perceptions Manager module
- Pay Practices Manager module
- Standard, Plus and Pro versions now available for the Workforce Compensation and Clinical Productivity Manager module
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SESSION 2: Physician Needs Assessment
Tuesday, August 3 | 12:00pm-12:45pm CT
SullivanCotter’s Physician Needs Assessment is an interactive cloud-based application that delivers accurate and actionable data-driven insights to help organizations identify, monitor and respond to changing service needs and physician and advanced practice provider staffing requirements in the communities they serve.
What's New?
- Market-specific assessment to provide accurate and detailed reporting of physician supply and demand
- Interactive mapping tool with the ability to select specific zip codes for strategic consideration
- Comprehensive customizable reports with 5-year rolling projections
REGISTER TO ATTEND >
SESSION 3: Provider Performance Management Technology™
Tuesday, August 10 | 12:00pm-12:45pm CT
With Provider Performance Management Technology™, organizations can build trust and engagement with the clinical workforce through actionable and transparent performance-based compensation administration, contract management, reporting and analytical capabilities.
What's New?
- Panel attribution and compensation management capabilities
- Automated clinical draw calculations and payments
- Automated split-role compensation calculations
- Full-scale physician contract lifecycle management
REGISTER TO ATTEND >
PRESS RELEASE | SullivanCotter’s Not-for-Profit Practice Welcomes Amanda Wethington
Supporting not-for-profit organizations in the attraction, retention and motivation of high-caliber talent
June 29, 2021 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, welcomes new Principal Amanda Wethington to the firm’s Not-for-Profit Practice. Joining practice leader Nanci Hibschman, Amanda will help to support SullivanCotter as it continues to expand its advisory services, proprietary survey data and insights to better serve the not-for-profit sector nationwide – including private and community foundations, higher education, policy and research institutes, trade and professional associations, and other service and charitable organizations.
With nearly 20 years of experience delivering comprehensive workforce compensation and performance solutions across a number of industries, Amanda leverages data-driven insights to help organizations align total rewards, recognition, and talent management programs. She works to solve the unique challenges that not-for-profit organizations face in the attraction, retention, and motivation of high-caliber talent.
She serves as a close advisor to boards and leadership on executive and employee total rewards programs with a focus on improving the design, development and implementation of compensation and performance management programs to enhance alignment with an organization’s mission, vision and values.
“In today’s complex operating environment, high-performing not-for-profit organizations require increasingly competitive compensation, benefits and talent strategies in order to stay ahead of the curve. Amanda’s in-depth experience in delivering effective total rewards strategies, including diversity, equity and inclusion initiatives, will serve our clients well as they continue to look for guidance on developing innovative programs that support key organizational objectives,” said Nanci Hibschman, Managing Principal and Not-for-Profit Practice Leader, SullivanCotter.
Prior to joining SullivanCotter, Amanda led the Workforce Rewards Team as a Senior Principal at a global management consulting firm. She also spent 10 years working in human resources and compensation at Hyatt Hotels Corporation.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
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Advanced Practice Provider Leadership Structures
The Evolution of a Well-Defined Advanced Practice Provider Leadership Structure
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Featured in AAPL's Physician Leadership Journal
Advanced practice provider leadership is critical to the optimization of the growing APP workforce.
COVID-19 has accelerated the financial and operational challenges facing the health care industry and organizations are reevaluating current processes and structures. As a result of this pandemic, some health systems and medical groups are planning for an increasingly uncertain future. These changes have also presented the opportunity to design more effective care delivery models, right-size cost structures, and streamline organizational processes to enhance financial sustainability going forward.
Prior to the pandemic, many hospitals and health systems had begun to prioritize the integration, optimization and engagement of their advanced practice provider (APP) workforce as a strategy to enhance organizational performance and support the transition to value-based care. In response to COVID-19, many organizations are utilizing their APPs to support operations. This has, in many cases, helped to accelerate the optimization of these clinicians.
As one of the fastest-growing workforces in health care, APPs constitute, on average, more than one-third of an organization’s clinical workforce. APP leaders are critical to the organization and optimization of this workforce. The presence of a well-defined advanced practice provider leadership structure can drive organizational performance and support a comprehensive APP workforce strategy – which can help to improve access, increase revenue and reduce costs. Understanding the evolution of APP leadership positions at the top, clinical, managerial and functional levels, along with their different roles and responsibilities, can serve as a roadmap for organizations as they continue to build out and develop their own APP structures and programs.
PRESS RELEASE | Sophisticated Compensation Enhancements Added to PPMT™
SullivanCotter's comprehensive physician compensation software now includes innovative automation enhancements for its new Clinician Pay feature
June 15, 2021 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, announces the addition of highly-anticipated new compensation automation enhancements to its growing physician compensation software solution – Provider Performance Management TechnologyTM (PPMT).
With the new Clinician Pay feature, PPMT™ now enables users to streamline the compensation management process by automating clinical draw calculations and payments based on current performance and organization-defined criteria. It offers flexible and sophisticated rules for the draw calculations that are easily maintained by key administrative stakeholders and can be managed throughout the year.
“Determining clinician draw for the upcoming year is a significant and burdensome time investment for compensation program administrators. Most often, these calculations are done manually via spreadsheets – which can greatly increase the risk of error. Using PPMT™, organizations can now automate the production of accurate and reliable draw and other pay calculations within one system”, said Shelly Slowiak, Director, Product Support, PPMT™, SullivanCotter.
New split role compensation automation eliminates the need to manually determine clinical and non-clinical pay components by providing visibility into performance and compensation for different roles while also allowing administrators to view aggregate compensation for each individual clinician.
“In order to provide the best care for patients, a growing number of physicians are specializing in multiple service areas with varying compensation arrangements. This often requires greater attention and additional analysis from an already overextended compensation team. PPMT™ can ease the administrative burden by effectively automating and providing consistent compensation calculations for each service area”, said David Schwietz, Chief Information Officer, SullivanCotter.
Designed to address a spectrum of physician, leadership and other key stakeholder needs, PPMT™ combines years of health care compensation insight and expertise with an intuitive and automated technology platform to help drive provider performance and support the transition from volume- to value-based care.
For more information on these enhancements or our entire suite of Provider Performance Management Technology™, visit www.sullivancotter.com/PPMT or contact us at 888.739.7039.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
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Advanced Practice Provider Utilization and Compensation | Case Study
Optimizing advanced practice provider utilization to increase retention and engagement
Featuring a case study from a large academic medical center
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At a time when health care organizations remain focused on pandemic-related financial and care delivery challenges, there is an acute need to engage and retain the clinical workforce by reducing burnout and unexpected turnover – and how advanced practice provider utilization within the care team can have a significant impact on both.
As organizations look for better ways to support their growing APP workforce, they require an intentional approach that aligns compensation design more closely with the goals of care team optimization in order to reduce costs and improve team performance.
In an article written by SullivanCotter and published by the American Association of Provider Compensation Professionals, learn more about how one organization set the stage for optimal APP utilization and care team delivery by also addressing important compensation issues at the same time.
PRESS RELEASE | SullivanCotter Names New Independent Members to its Board of Directors
New Independent Directors will play a pivotal role in providing the additional insight, experience and external perspective needed to support business strategy, ensure organizational growth and maintain independence
May 18, 2021 – Chicago –SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce the addition of five independent advisors to the firm’s Board of Directors.
“While our firm continues to expand and evolve amidst a number of unprecedented industry changes, advancing our strategic plan to help better serve the dynamic and unique needs of our clients remains a top priority. By inviting an accomplished group of Independent Directors to join our Board, we hope to leverage their strategic thinking, market knowledge and many years of combined experience as we move forward into 2021 and beyond,” said Ted Chien, President and CEO, SullivanCotter.
In an effort to prioritize best practices in governance, information technology, financial and human capital development, and diversity, equity and inclusion, SullivanCotter welcomes the following Independent Directors to the Board:
- Gina Alexander – Current Chief Financial Officer for AlixaRx, a privately-held, technology-enabled pharmacy services company serving the long-term care and corrections market.
- Brian Dunn – An experienced consultant who retired as the Chairman of McLagan and the CEO of Performance, Reward and Talent at Aon Consulting.
- Frances Ferguson – An accomplished C-Suite executive with more than 25 years of experience who most recently served as Group Executive, Managing Director and the Chief Administrative Officer of the Financial Markets and Treasury Services Sector operations at BNY Mellon Bank.
- Paul Keckley – Managing Editor of The Keckley Report, a health care policy analyst and widely known industry expert who advises health care organizations on long-term growth, sustainability, and advocacy strategies.
- Robert Oberrender – A decorated financial executive who recently retired as the Chief Investment Officer and Treasurer of UnitedHealth Group in October 2018.
As SullivanCotter continues to innovate through its performance-focused advisory services and growing suite of technology, survey and data products, these new members will play a pivotal role in providing the additional insight, experience and external perspective needed to support business strategy, ensure organizational growth and maintain independence.
To learn more about SullivanCotter’s Board of Directors, visit us at SullivanCotter.com or call 888.739.7039.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
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PRESS RELEASE | SullivanCotter Welcomes Information Security Officer Jeff Peal
Ensuring client-facing solutions remain highly effective, secure and compliant
April 27, 2021 – Chicago –SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce the addition of Jeffery A. Peal as its Information Security Officer.
With over 20 years of cybersecurity and information technology experience, Jeff has a longstanding passion for providing business-enabled solutions while also managing risk and strengthening organizational security. His demonstrated ability to envision, lead and implement innovative IT programs helps to enhance security awareness, increase productivity, and mitigate risk and exposure.
“Now more than ever, the not-for-profit and health care industry continues to transform its information security practices at a rapid pace. As our clients look to stay ahead of the curve in an increasingly complex environment, SullivanCotter continues to innovate through its growing suite of technology, survey and data products. With Jeff’s specialized knowledge and expertise in business intelligence, data and information security, he will play a pivotal role in our risk-based approach to ensure the firm’s client-facing technology solutions remain highly effective, secure and compliant,” said David Schwietz, Chief Information Officer.
Jeff works closely with clients to support compliance and assist with the way data is secured, managed and stored. He also directs SullivanCotter’s information security growth initiatives and resources internally to help drive greater value for clients. This includes establishing enterprise-level security initiatives, leading high-performing teams across a number of technical and analytical support areas, designing strategic information security policies, and auditing software and application vulnerability.
Prior to joining SullivanCotter, Jeff spent more than 20 years with the Federal Reserve Bank of Minneapolis where he most recently served as the Information Security Officer.
He also works as an adjunct professor and community faculty member at two Minneapolis-based technical colleges and universities to support higher education in information security and expand and develop local talent in this field.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
READ ON NEWSDIRECT
PRESS RELEASE | Benchmarks360™ - APP Utilization and Perceptions Manager
SullivanCotter Releases Comprehensive APP Utilization and Perceptions Manager for its Growing Benchmarks360™ Platform
April 21, 2021 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce the addition of powerful new capabilities for assessing advanced practice provider (APP) utilization and workforce perceptions to its growing Benchmarks360™ platform.
Powered by SullivanCotter’s proprietary surveys and research, Benchmarks360™ is a suite of intelligent, web-based products that enables health care organizations to analyze and visualize compensation, clinical productivity and workforce perceptions through industry-leading data, analyses and reporting.
"In today's unprecedented health care environment, it is important for organizations to utilize, engage and retain their clinical workforce more effectively. APP turnover can significantly impact cost, morale and operations, and gaining access to the right data and benchmarking tools can help to enhance workforce retention, team-based care practices and organizational performance during such a critical time,” said Amy Noecker, APP Workforce Practice Leader, SullivanCotter.
SullivanCotter’s Benchmarks360™ APP Utilization and Perceptions Manager allows organizations to collect, benchmark and report on the thoughts and experiences of their APPs and physicians related to APP compensation, resources and job responsibilities to help ensure current pay programs and care models are competitive and effective. In addition to data on nurse practitioners and physician assistants, it also provides information and analysis on other members of the APP workforce including certified registered nurse anesthetists and certified nurse midwives.
This new module includes two surveys designed to measure and compare individual organizations to national benchmarks.
APP: Utilization and Perceptions Survey
Learn more about the APP employment experience within your organization regarding scope of practice, clinical and non-clinical responsibilities, and perceptions on culture and compensation. Specific insights include:
- Organizational structure, support and processes related to the APP workforce
- Roles on the care team specific to location and specialty
- Degree of integration and care team support
- Opportunities for improved utilization and engagement
Physician: APP Utilization and Perceptions Survey
Learn more about your physician workforce and their experience working with APPs. Specific insights include:
- Perception on APP integration and utilization
- Roles of APPs on the care team
- APP impact on quality, access and patient engagement
- Understanding of regulatory requirements
- Opportunities for improved alignment and team performance
These surveys may serve as a resource for organizations looking to better understand the current state of their APP workforce – including quantifying opportunities for optimization and readiness for change – and can play an important part in a more holistic review of APP practices when combined with SullivanCotter’s comprehensive advisory services.
“As health care organizations continue to navigate the lasting effects of a global pandemic, SullivanCotter remains committed to providing them with the critical, data-driven insights they need to measure, analyze and report on compensation and workforce performance. With the goal of addressing the increasingly complex and evolving needs of our clients, we are developing one of the industry’s most comprehensive benchmarking solutions by continuously refining our product roadmap and adding innovative new resources and functionality,” said David Schwietz, Chief Information Officer, SullivanCotter.
To learn more about Benchmarks360™, including important licensing information and a full list of features and functionality, visit sullivancotter.com/benchmarks360 or call 888.739.7039.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology products to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
READ ON NEWSDIRECT
Case Study | Union Health – Population Health Management
Improving Patient Care and Optimizing Financial Performance
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As health care continues to shift from productivity and fee-for-service models to more of a quality and performance-based approach, value-based care (VBC) strategies, including population health management (PHM) programs, are becoming a top priority for health care systems across the nation. Leaders within these organizations are searching for more effective and sustainable solutions as they navigate declining reimbursement, regulatory changes, physician burnout and the need for better patient care and lower costs.
These challenges can be addressed with a tailored PHM strategy that supports organizational improvement in the following key areas:
- Maximizing operational processes and outcomes
- Developing a support network for physicians and advanced practice providers (APPs)
- Mitigating risk
- Enhancing performance in a value-based environment
By identifying actionable and targeted opportunities for improvement through a series of evaluations and readiness assessments, Union Health, an integrated, not-for-profit health system based in western Indiana, was able to develop comprehensive VBC and PHM strategies better aligned with their patient-focused approach to coordinated care.
The Situation
As a six-year participant in a local, tertiary accountable care organization (ACO), Union Health had fully outsourced its operational leadership to the parent ACO member. This legacy partnership and arrangement was simply not producing the desired results from a clinical, operational or financial perspective for Union Health – with data and analytics, physician engagement, embedded care management and post-acute care spend being specific areas of concern. Around 2018, Union Health was at a strategic crossroads in regard to its investment in VBC initiatives as the PHM program was not generating the desired results.
This highlighted the need to more effectively integrate operations across departments and service lines, align incentives for leadership and physicians, and reallocate related resources. At the same time, many competing health systems in Indiana were already realizing the benefits of a highly functional PHM program. The leadership at Union Health recognized the key to success would be through a more consistent approach, improved internal processes and engaged leadership.
The organization decided to narrow its focus by strengthening internal capabilities around care management, physician engagement, analytics and reporting to help ensure greater levels of risk-based contracting success with the Centers for Medicare and Medicaid Services (CMS) and other commercial payors.
The Approach
In late 2018, Union Health was presented with an opportunity to partner and align with a nationally recognized health system in a more advanced Next Generation ACO. A Next Generation ACO model offers more risk and reward (both upside and downside risk scenarios) for health systems who already have highly functional internal capabilities in place to support performance. These models represent some of the most advanced value-based arrangements and require greater system-wide operational sophistication. Union Health was looking for a hands-on approach to align initiatives and ensure success.
In order to assess internal operational capabilities, physician and advanced practice provider engagement levels, incentive models and other key functional areas related to VBC, senior leadership at Union Health collaborated closely with SullivanCotter to help quantify this opportunity. After conducting a comprehensive VBC readiness assessment, which included a close examination of the program’s core functional areas such as partnerships, utilization management, attribution and chronic disease management, Union Health elected to partner with the larger health system who had already demonstrated greater success in the Next Generation ACO model. Moreover, Union Health committed to this arrangement for a minimum of two years to support the development of a strong VBC program. Health systems across the country often partner and align with other systems or independent groups to help mitigate risk and better manage overall cost.
SullivanCotter’s primary role with Union Health was to develop and implement an independent PHM program that would help to improve risk-based contracting performance. The program focused on five core principle areas:
- Annual care
- Risk acuity
- Utilization management
- Care management
- Incentive alignment
With these principles in mind and a significant amount of physician and APP input and collaboration, the design of the system’s VBC strategy and approach included the following phases:
To help implement the multi-phased strategy, a task force consisting of Union Health’s executive team and leaders in Business Development, Population Health Management, Physician Services, Utilization Management and Care Management was created to help oversee the process. The initial phase of the project consisted of in-depth interviews with physicians and stakeholders, a thorough review of data and performance metrics, and an operational Readiness Assessment. Key findings from this phase revealed:
- Low engagement from physicians, APPs and other staff with annual care and preventative medicine strategies
- Significant lack of Care Management resources and coordination such as outpatient pharmacy support, discharge planning and risk stratification
- Limited definition of roles and responsibilities for Care Management and Operations team members specific to VBC and PHM
- Insufficient value-based data resources such as reporting capabilities, quality dashboards and clarity surrounding key performance indicators
- Lack of clarity in the scope of practice for nurse practitioners and physician assistants in current team-based care model
- Physician and APP compensation and incentives were not aligned with VBC strategies and initiatives; no incentive for physicians and APPs to enhance value-based performance
- The CMS benchmark or threshold was not met in the contract in order to achieve shared savings – resulting in negative financial impact and poor contract performance
Using the findings from this readiness assessment, SullivanCotter helped executives and physicians at Union Health to further develop a roadmap for the Program Development and Implementation phase.
Roadmap initiatives included the development of:
- Physician and APP educational and engagement materials for workshop sessions
- Clearly defined roles and scope of practice for nurse practitioners and physician assistants in primary care
- Outpatient-focused clinical capacity analysis to support Care Management
- Comprehensive annual care strategy focused on prevention and wellness
- VBC Management team to monitor performance and contract relationships
- Physician and APP incentive components to enhance VBC and PHM
- Standardized dashboards for the entire care team
- Post-acute care strategies more closely aligned with Care Management
- Strategies to monitor ongoing performance
Once the initial components of the roadmap were deployed, the task force worked with SullivanCotter to begin the planning process for two remaining phases within in the PHM model: Physician and APP Incentive Alignment and Performance Review and Monitoring. These processes were also implemented and rolled out during PHM program development and focused on monitoring and enhancing performance in all value-based contracts.
The work accomplished in these two phases included:
- Population health metrics related to annual care, preventative screenings, vaccinations, utilization management, Care Management team engagement and risk-adjustment
- Value-based compensation design concepts and continued education provided to physicians and APPs
- Regular monthly huddles with Care Management team members to review patient volume
- A risk stratification process to determine appropriate care levels for patients
- Physician and APP interviews for feedback and evaluation
- Physician and APP engagement scoring and methodology
- Refinement of key performance indicators
- Development and rollout of physician and APP performance dashboard
The Results
Through the investment in and development of the PHM program and other related VBC initiatives, Union Health was able to achieve the following results over a 12-month period:
- Achieved significant shared savings in year one of the Next Generation ACO as compared to historical performance with improvement of over $6M
- Reduced per member per month spend compared to prior year by 12%
- Implemented a newly redesigned approach to primary care by focusing on team-based care delivery
- Increased the number of completed and billed Medicare Annual Wellness Visits (AWV) from 900 to 5900 with AWV revenue up from approximately $150,000 to $944,000
- Raised the number of documented Care Management team episodes by more than 200%
- Lowered number of emergency room visits in the Next Generation ACO population that were deemed “PCP treatable”
- Documented more than 100 Care Management success stories
- Boosted the clinical diagnosis documentation rate by more than 20%
- Enhanced coordination with post-acute care partners and facilities to help reduce total cost of care for ACO patients by 11%
- Conducted regular meetings and monthly Care Management huddles to enhance physician and APP engagement with knowledge of VBC and PHM concepts and monitoring of individual performance
- Initiated strategic planning to redesign primary care and other specialty compensation models with a focus on performance and value
Tips for Successful VBC/PHM Program Implementation
- Assign dedicated resources to care team optimization
- Collaborate with and gather input from physicians and APPs to strengthen engagement and buy-in
- Align physician and APP incentives to help streamline and reward clinical efforts
- Establish achievable milestones to maintain momentum and engagement
- Conduct regular key stakeholder meetings to provide updates on progress, celebrate successes and course-correct as needed
Lessons Learned
Despite the many factors that differentiate health systems, such as organizational size, complexity, or the communities they serve, there are a common set of fundamental guiding principles and success factors that can be tailored to each organizations’ VBC and PHM strategies.
Union Health’s multi-phase approach – including Readiness Assessment, Program Development and Implementation, Physician and APP Incentive Alignment, and Performance Review and Monitoring – has proven to be an effective way of improving overall performance through the creation of comprehensive VBC and PHM strategies.
Dedicated to enhancing internal capabilities, resources and value-based performance with the objective of improving population health, Union Health partnered with SullivanCotter to develop a long-term, sustainable strategy and implement a comprehensive program to help to improve access and health outcomes for its patients, strengthen physician and APP engagement, and significantly boost financial performance.
Leveraging data-driven insights and over 25 years of experience, SullivanCotter partners with organizations to develop comprehensive value-based care and population health management strategies tailored to the unique needs of each client.
Contact us for more information.
INFOGRAPHIC | Certified Registered Nurse Anesthetists: Compensation and Pay Practices
Detailed insight into CRNA compensation, pay practices, work effort and more
In addition to providing critical base salary and total cash compensation benchmarking information for this important subset of the APP workforce, SullivanCotter’s Advanced Practice Provider Compensation and Productivity Survey has now expanded to include detailed insight into CRNA-specific pay practices as well.
While CRNAs are vital members of this growing workforce, the unique nature of their roles includes key differences in work effort and premium pay practices when compared to other APPs.
View highlights from the 2020 survey results to learn more!
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WEBINAR | The Impact of the Changing Health Care Environment on Primary Care
Is your organization struggling to address the impact of COVID-19, changes to the Stark Law and updates to the Physician Fee Schedule?
Tuesday, April 27 | 10-11am CT
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Hosted by the American Association of Provider Compensation Professionals (AAPCP)
Prior to the onset of COVID-19, the changing reimbursement environment and transition to value-based care were impacting primary care compensation design and pay practices. Today, as health care organizations nationwide are navigating an increasingly complex operating environment, COVID-19 continues to place pressure on financial sustainability, patient access and population health management.
Combined with changes to the Physician Self-Referral Law (Stark) and updates to the 2021 Physician Fee Schedule and Evaluation & Management CPT codes, health care organizations are rapidly engaging in the redesign of their primary care compensation programs.
During this session, SullivanCotter will highlight relevant market trends impacting contemporary primary care compensation design and discuss evolving plan methodologies and approaches as organizations plan for the future.
ON-DEMAND WEBINAR | Optimize Clinical Resources to Support Population Health Management
Understanding the Strategic Impact of a Physician Needs Assessment
Wednesday, May 19 | 12:30-1:30PM CT
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Hosted by the American Hospital Association/Health Forum
Access to market-specific physician supply and demand data is critical as hospitals and health systems look to support growth, enhance value-based care delivery, and reassess cost and efficiency concerns.
Health care organizations must identify the right amount and type of physician specialties to operate effectively in the markets they serve with the goals of optimizing clinical performance as the focus on value-based care and population health management intensifies.
Learn how accurate and actionable data-driven insight can help hospitals and health systems to identify, monitor and respond to changing service needs and physician and advanced practice provider (APP) staffing requirements. Decide strategically whether to recruit, employ or affiliate to create a competitive edge in today’s rapidly evolving health care environment.
During this webinar, industry experts from SullivanCotter will discuss:
- Partnering with Union Health on strategies to support expanded value-based care and population health management requirements
- Evaluating the market-specific drivers that influence physician demand
- Accurately pinpointing employed and affiliated market physicians by specialty
- Leading practices and innovative approaches to inform physician strategy and alignment efforts to enhance performance
- Creating a competitive edge by optimizing clinical resources
Case Study | The Key Role of Advanced Practice Providers in Today's New Normal
Featuring Stanford Health Care's Strategy to Heighten APP Integration and Engagement
As health care organizations nationwide continue to balance managing the immediate implications of the COVID-19 pandemic with planning for what lies ahead, many are looking to optimize team-based care delivery to help address emerging operational challenges, maintain financial sustainability, and meet evolving patient needs.
With the ability to direct patient care and generate revenue, advanced practice providers (APPs) are critical members of the care team and can play an important role in this transformation.
Featuring a case study published in AAPL's Physician Leadership Journal, learn more about how SullivanCotter partnered with Stanford Health Care to develop a comprehensive strategy and program to maximize utilization, support optimization and enhance engagement for its growing APP workforce.