PRESS RELEASE | SullivanCotter Integrates Health Care Contract Management Solution into PPMT™

Partnering with Ntracts to deliver full-scale contract lifecycle management capabilities

November 30, 2020 – 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, has partnered with Ntracts, a premier health care contract management solution, to incorporate full-scale contract lifecycle management as part of its comprehensive Provider Performance Management Technology™ (PPMT) platform. PPMT™ is an industry-first, cloud-based solution that enables engagement and alignment of the clinical workforce through the automation of performance-based compensation administration, analytical and reporting capabilities. Ntracts allows organizations to mitigate contract compliance risk and streamline the contracting process across the entire enterprise.

Designed to address a spectrum of physician, leadership and other key administrative needs, PPMT™ delivers centralized and actionable data tailored to the unique needs of each stakeholder. It combines years of health care compensation insight and expertise with an intuitive, automated technology platform, and serves as a single source of truth that helps empower physicians to drive desired outcomes and enhance organizational performance.

Ensuring that physician employment agreements align with system-wide compensation terms and payments remains a challenge for health care organizations nationwide. With the addition of Ntracts, PPMT™ will include a cutting-edge contract lifecycle management component that will provide hospitals and health systems with an accurate and comprehensive view of clinical employment contracts across the organization in real-time. By effectively integrating the compensation, performance and contract lifecycle management process into one centralized platform, PPMT™ will help to drive results through greater alignment, transparency and insight.

“Health care continues to evolve at a rapid pace, and there are number of complex moving parts to navigate as it relates to physician compensation and performance. By adding critical contract management capabilities to help health care organizations reduce risk, maintain compliance with changing regulatory requirements, and improve operational efficiency, PPMT™ will be a full-scale solution designed to support the transition from volume to value-based care,” said David Schwietz, Chief Information Officer, SullivanCotter.

David Paschall, Chief Executive Officer of Ntracts, adds, “SullivanCotter shares our commitment to quality and we are proud to combine our industry-leading contract lifecycle management solution with SullivanCotter’s expertise in physician compensation and performance. Together we can offer an unmatched, end-to-end technology solution to support health care organizations as they work to drive change and deliver long-term, sustainable results in this quickly evolving environment.”

For more information on 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.

About Ntracts

Ntracts, Inc. offers a software-as-a-service application that enables users to originate, search for and report on contracts. The application also accelerates the contract review and approval process by automatically notifying responsible parties of contract requests, approaching expiration dates and other critical performance milestones, saving clients both time and money. Ntracts, Inc. is based in Indianapolis, Indiana, and was founded by Hall, Render, Killian, Heath & Lyman, the nation's leading health care law firm.


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PRESS RELEASE | Annual results from SullivanCotter's Physician Compensation and Productivity Survey

Physician Compensation Programs Shifting to Address Changing Market Dynamics and Mitigate COVID-19 Financial Implications

November 11, 2020 – 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, recently released results from the 2020 Physician Compensation and Productivity Surveywhich represents data from more than 800 organizations on nearly 244,000 individual physicians and advanced practice providers. The results reflect calendar year 2019 and, as the last set of benchmark data available prior to the onset of COVID-19, this year’s survey will serve as an important resource for organizations needing pre-pandemic compensation reference points for this critical workforce.

“Although the pandemic has created a great deal of uncertainty – with many organizations making near-term modifications to their physician compensation programs as a result – we’re seeing a slow and steady adjustment to the ‘new normal’ as patient volumes have returned to approximately 90% of pre-COVID-19 levels. In some ways, the fallout from COVID-19 has simply accelerated the forces that were driving physician compensation changes prior to the pandemic, and the 2020 survey data will be very important in helping to determine how organizations are responding to these challenges,” said Tim Stamper, Senior Consultant, SullivanCotter.

Physician Total Cash Compensation (TCC)

While TCC has grown, on average, 2.5% annually since 2012, COVID-19-related reductions in surgical and non-emergent care have impacted the financial condition of many health care organizations nationwide – causing them to implement or consider a number of compensation and benefits-related modifications to help offset significant losses in revenue. According to SullivanCotter’s COVID-19 Physician and Advanced Practice Provider Compensation Practices Survey series, nearly 30% of participants had implemented or were considering pay reductions for front line physicians and nearly 40% of participants were doing the same for non-front line physicians as of May 2020. Median pay cuts were 11% and 15% for front line and non-front line physicians respectively. Other organizations made cuts in physician benefits in response to COVID-19. The most common benefit program changes in 2020 included eliminating or reducing retirement plan contributions, adjustments to PTO policies, and eliminating or reducing CME allowances. The majority of these actions were intended to be temporary and, as patient volumes continue to increase and organizations start to recover financially, many are returning to historical pay and benefits practices.

Due to the financial impact of COVID-19, physician incentive programs have also come under scrutiny in 2020. Among respondents surveyed in May, 16% of organizations reported eliminating or reducing non-productivity incentive compensation in 2020 while an additional 38% were considering this action. Many organizations pay out these incentives at year-end, making these programs an obvious target for cost-reduction.

Physician Productivity

The 2020 Physician Compensation and Productivity Survey results continue to show a trend of flat or even declining median work RVU (wRVU) productivity across all major specialty categories. Since TCC showed modest increases in the 2020 survey, TCC per wRVU ratios have also increased. While we have anticipated growth in value-based incentives, wRVUs and productivity-based incentives still determine the majority of incentive or variable compensation as a percentage of TCC. Approximately 70% of organizations utilize wRVUs to determine compensation for primary care and specialist physicians, with wRVU productivity accounting for about 18% of TCC in plans with a base salary component and over 90% of TCC in plans without a base salary component. Less than half (44%) of organizations surveyed include a wRVU component for hospital-based physicians, who are instead paid primarily on base salary and shift-based models.

As organizations focus their attention on maintaining patient access and minimizing the financial losses created by COVID-19, the emphasis on individual wRVU productivity will remain prominent. While the pandemic itself has had a sizable impact on patient volumes and physician productivity, the Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the Evaluation & Management wRVU values loom large as organizations look ahead to 2021. These adjustments include an increase in wRVUs for most office-visit E&M codes due to added responsibilities physicians have absorbed over the last five years. As a result of the overall projected increased in wRVUs, a 10.6% reduction in the conversion factor was required in order to maintain budget neutrality. The proposed increase in wRVU values ranges from 28%-46% for established office visits, which will have a significant impact on compensation plans that use wRVUs as a determinant of compensation.

Considerations for 2020 and Beyond

Although COVID-19 has sharpened industry focus on supporting financial sustainability, other market dynamics and the timing of anticipated financial recovery are also influencing the way hospitals and health systems are approaching physician compensation in both the short and long-term.

“Considering the implications of COVID-19 in 2020 and the impending impact of wRVU changes in 2021, the 2020 survey benchmark data represents the best data reference point for use in the near future. With appropriate context, it can serve as a foundation for understanding specialty market positioning leading into COVID-19, identifying recruitment and retention risks, and pinpointing areas of focus for targeted compensation adjustments as your organization moves forward with 2021 planning,” said Dave Hesselink, Principal, SullivanCotter.

There are a number of important physician compensation considerations for organizations to assess as they continue to navigate the new normal:

  • Be mindful of how to appropriately use 2020 survey data. Understand the timing of the data and consider what you are trying to assess before using it. It can be helpful in benchmarking the competitiveness of compensation program elements and incentive opportunities.
  • Develop an approach to physician compensation now in response to CMS’ proposed wRVU changes. Organizations should be proactive in assessing how these changes will impact payer reimbursement and physician compensation programs.
  • With continued uncertainty regarding the impact of the pandemic in FY2021 and beyond, be prepared for new pandemic-related challenges to patient revenues and physician compensation. Organizations would be well-advised to have a plan developed in advance of any new restrictions on elective and non-emergent care to mitigate additional financial losses.

For more information on SullivanCotter’s surveys or the upcoming Evaluation and Management wRVU value changes, please visit our website at www.sullivancotter.com, email us or contact us by phone 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 products 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 | Results from SullivanCotter's Annual Health Care Executive Compensation Survey

Offering insight into pandemic-related pay actions and considerations for 2020 and beyond as health care organizations plan for what lies ahead

November 5, 2020 – ChicagoSullivanCotter, 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, recently released results from its 2020 Manager and Executive Compensation in Hospitals and Health Systems Survey which is now in its 28th year. This year’s results include information from more than 2,300 organizations. More importantly, the survey contains the last set of benchmark data compiled prior to the onset of COVID-19 and provides important pre-pandemic reference points for assessing executive compensation programs.

“While pay actions are being impacted by the pandemic, the foundational structure of executive compensation programs has generally remained unchanged. The 2020 survey data can be used to assess the competitiveness of base salaries, the level of incentive opportunities and other program design considerations. In light of the impact of the pandemic on business operations, now is an appropriate time to evaluate the broader implications of COVID-19 on your talent strategy, compensation philosophy and program design to ensure they reflect your organization’s new priorities,” said Tom Pavlik, Managing Principal, SullivanCotter.

Executive Base Salaries in 2020

In recent years, executive salaries were trending upward due to the focus on recruitment and retention of key leadership talent and an increasingly complex health care market. When comparing data reported by organizations that participated in SullivanCotter’s survey in both 2019 and 2020, median base salaries going into 2020 increased at a rate of 3.4% to 5.6% for the most senior executives of independent health systems (Vice Presidents, Senior Vice Presidents, CFOs, COOs and CEOs) as opposed to 0.8% to 4.1% for those executive positions at system-owned hospitals.

However, due to the financial impact of COVID-19, many organizations have implemented temporary executive base salary reductions. According to SullivanCotter’s COVID-19 Executive and Employee Compensation Practices Survey series, which was conducted between April 2020 and August 2020 to provide insight into the current practices of more than 100 large health systems, only 14% of organizations were considering or had implemented executive base salary reductions as of April. By May, this number had risen to 31%. Through August, implemented salary reductions reached 45%. However, of this 45%, nearly half had already reinstated the pre-pandemic salaries with the remainder expected to do so by the end of the year.

Executive Base Salary Increase Budgets

An analysis of the survey data indicates that, prior to COVID-19, median salary increase budgets for health care executives were expected to remain consistent with recent years at 2.7% for independent health system executives and 3.0% for system-owned hospital executives. The pandemic has impacted the financial condition of many organizations and is moderating salary increase plans for FY2021.

According to SullivanCotter’s proprietary COVID-19 research, about 40% of organizations had determined their FY2021 executive salary increase budgets by mid-August. The preliminary median executive salary increase budget is 2.5%, with 15% planning to freeze executive salaries. The other 60% of organizations had not yet determined their salary increase budget, and 20%-25% are delaying the timing of these increases. These figures may change over time as financial performance will impact the ability to fully fund planned budgets, and it is anticipated that more organizations may consider executive salary freezes for FY2021.

Executive Annual Incentive Plans

Executive annual incentive plans (AIPs) are still the norm as organizations are increasingly focused on system-wide alignment and pay-for-performance. Prior to COVID-19, 89% of independent health systems and 67% of system-owned hospitals utilized AIPs with award opportunities varying by health system size based on net revenue.

According to SullivanCotter’s research, however, COVID-19 has had a significant impact on executive incentive plans for FY2020. As of mid-August, more than half of the participating organizations had implemented or were still considering changes to FY2020 plans. While one-third did not yet know how they will handle their FY2020 annual incentive payouts, approximately 20% are eliminating or considering eliminating payouts, nearly 30% expect to pay below target, and only about 20% expect to pay at target or above.

Considerations for 2020 and Beyond

As hospitals and health systems plan for what lies ahead and look to support financial sustainability and mitigate risk, organizations should consider both market practices and their individual financial circumstances when determining their executive compensation and workforce-related actions moving forward.

“SullivanCotter’s 2020 survey reflects the most recent normative year prior to COVID-19. Due to the current pandemic and the extremely dynamic environment, the survey data should be used thoughtfully, with appropriate context, and with sound business judgement as you are planning and considering your pay decisions for FY2020 and beyond,” said Bruce Greenblatt, Managing Principal, SullivanCotter.

There are a number of important executive compensation considerations for organizations to consider as they move forward:

  • Be mindful of how to appropriately use 2020 survey data. Understand the timing of the data and consider what you are trying to assess before using them. The data can be helpful in benchmarking the competitiveness of compensation program elements and award opportunities.
  • Rely on sound business judgement and discretion when evaluating base salary actions and incentives for FY2020.
  • Plan to revisit incentive performance goals for FY2021 to ensure they are tailored to the current environment.
  • Assess the broader impact of COVID-19 on executive talent strategy and review the compensation philosophy and program design.
  • With continued uncertainty in FY2021 and beyond, remain mindful of the environment and be flexible.

For more information on SullivanCotter’s surveys, please visit our website at www.sullivancotter.com, email us or contact us by phone 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 products 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 Releases Enhanced Patient Panel Management Capabilities for PPMT™

Automate the assignment of patients to clinician panels through sophisticated organization-defined rules

October 28, 2020 – ChicagoSullivanCotter, 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, launches expanded patient panel management functionality in the latest update of its comprehensive Provider Performance Management Technology™ (PPMT). PPMT™ is an industry-first, cloud-based product that enables provider engagement through transparent performance-based compensation administration, reporting and analytical capabilities.

As the focus on optimizing team-based care to achieve better patient outcomes intensifies, health care organizations require more effective strategies and resources for facilitating patient panel management. PPMT™ enables organizations to automate the assignment of patients to clinician panels through sophisticated client-defined rules. It then calculates a risk-adjusted panel size and applies compensation calculations for a group or individual based on an organization’s requirements – providing the flexibility to change patient attribution and/or panel compensation assignments as clinical teams evolve. PPMT™ allows for greater transparency into panel composition and serves as a single, centralized source of truth for clinician compensation.

“Properly attributing patients to the correct clinician’s panel can require hours of administrative time each month. Combined with detailed analytics and powerful auditing and adjustment tools, the new panel management functionality streamlines this process to ensure more accurate attribution and support effective panel management programs,” said Shelly Slowiak, Director, Product Support, Provider Performance Management Technology™, 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, automated technology platform to help drive clinician performance and support the transition from volume- to value-based care. It incorporates SullivanCotter’s industry-leading benchmarking data into three integrated modules, including Provider Performance Management, Provider Productivity Insights and Compensation Management Analytics.

“We’re working hard to understand our clients’ changing needs and priorities and, as a result, will continue to refine our product roadmap and deliver the functionality they require to help navigate such a dynamic marketplace. This innovative new functionality will serve to strengthen our existing panel management capabilities, and is a welcome addition to PPMT™ as we strive to develop one of the industry’s most comprehensive, end-to-end technology products for managing clinical compensation and performance,” said David Schwietz, Chief Information Officer, SullivanCotter.

For more information on 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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PRESS RELEASE |
Hospital Sisters Health System Implements PPMT™

Hospital Sisters Health System Selects Innovative Technology Product to Automate and Enhance Physician Compensation and Performance Management Capabilities

October 13, 2020 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of rewards programs and workforce solutions for the health care industry and not-for-profit sector, has partnered with HSHS Medical Group and Prairie Cardiovascular, two Hospital Sisters Health System ministries, to implement its comprehensive Provider Performance Management Technology™ (PPMT).

Hospital Sisters Health System is a large, multi-institutional health system committed to delivering high-quality, patient-centered care to communities throughout Illinois and Wisconsin. By leveraging PPMT™, an industry-first, cloud-based product that enables physician and APP engagement through transparent performance-based compensation administration and analytical capabilities, the organization is looking to automate and align the management of clinician pay and performance across its medical group.

Driven by the need to provide a growing network of physicians with more accurate compensation and productivity data, HSHS Medical Group and Prairie Cardiovascular started the journey with an in-house application designed to enhance a process that was once very manual. Developing the right mix of internal resources and support to expand the application’s capabilities in line with the system’s evolving needs, however, proved difficult.

“We required a more comprehensive system with the ability to flex and scale with us as we add or change value-based incentives, modify compensation plans and analyze the impact of Evaluation and Management CPT code changes. PPMT™ will now enable us to automatically deliver extensive supporting documentation with drill-down capabilities to the patient-level for our clinicians to access any time they want. Providing this visibility and transparency is critical as we navigate an increasingly complex and rapidly changing health care environment,” said Linda Dace, System Vice President of Finance, Hospital Sisters Health System.

PPMT™ incorporates SullivanCotter’s industry-leading benchmarking data into three integrated modules, including Provider Performance Management, Provider Productivity Insights and Compensation Management Analytics. Hospital Sisters Health System selected all three modules to help support their goals - allowing for a more cohesive approach to compensation and performance management.

For more information on 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 and expertise 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 Launches New Physician Needs Assessment

SullivanCotter Launches New Physician Needs Assessment Application to Support Critical Staffing and Service Line Requirements

September 15, 2020 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of rewards programs and workforce solutions for the health care industry and not-for-profit sector, announces the launch of its new Physician Needs Assessment (PNA). SullivanCotter’s PNA is an interactive, cloud-based application that delivers actionable, data-driven insight into physician supply and demand to help organizations identify, monitor and respond to changing service line needs and physician workforce staffing requirements.

By leveraging real-time market intelligence, custom analyses and tailored forecasting scenarios, this innovative new PNA application enables organizations to dynamically address emerging market trends, changing population demographics and evolving physician practice patterns.

Using proprietary benchmark data from over 1,500 organizations and 400,000 physicians, SullivanCotter’s advanced methodology analyzes more than 1 billion unique claims annually to accurately calculate the physician surplus or deficit within a specific area by determining supply, forecasting wRVU utilization and adjusting to various market-specific demographics – including geography, economic factors, age/gender, payment types and managed care –  to calculate subsequent demand projections.

“In today’s increasingly uncertain marketplace, health care organizations remain acutely focused on recovery and what lies ahead in a post-COVID-19 operating environment. As hospitals and health systems look for better ways to support financial sustainability, assess clinical optimization opportunities, drive performance, and manage physician resources and service line needs, organizations must determine the right amount and type of physician specialties to operate effectively in the markets they serve ,” said Ted Chien, President and Chief Executive Officer, SullivanCotter.

Additional features and functionality include:

  • A rigorously researched, call-verified and editable physician and APP supply roster based on multiple data sources that includes tracking of employment and affiliations
  • Interactive mapping tool with the ability to select specific zip codes for strategic consideration and to account for any shifts in demographic mix
  • Predictive modeling to assess the impact of virtual care, urgent care, retail health and more
  • Advanced Practice Provider calculator to measure the impact of this workforce across specialties and their corresponding effect on physician supply and demand
  • Comprehensive, customizable reports with 5-year rolling projections and automatic annual updates to demand defined by demographic and geographic data
  • Archived reports providing strategic service area information and annual Stark compliance insights for measuring community need and assessing fair market value and commercial reasonableness considerations

Designed with the unique needs of leadership, physician and administrative stakeholders in mind, SullivanCotter’s PNA combines data-driven technology, industry-leading benchmark data and years of physician workforce consulting experience to provide organizations with the information and insights they need to inform key service line, practice and payer strategies in an evolving health care environment.

To learn more, request a demo, or view a full list of features and functionality, visit sullivancotter.com/PNA 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 and expertise 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 Launches Clinician Pay Functionality for PPMTTM

SullivanCotter Develops Powerful New Clinical Compensation Management Capabilities for its Growing PPMTTM Platform

September 1, 2020 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs and workforce solutions for the health care industry and not-for-profit sector, announces the addition of highly anticipated new Clinician Pay functionality to its growing Provider Performance Management TechnologyTM (PPMT) platform. PPMTTM is an industry-first, cloud-based solution that enables provider engagement through transparent performance-based compensation administration and analytical capabilities.

Clinician Pay enables administrative stakeholders to easily manage annual compensation draws and payroll adjustments through a centralized, secure and auditable source within PPMTTM. The new functionality can be added as part of the platform’s comprehensive Compensation Management Analytics module for an additional licensing fee. This module’s broader capabilities allow organizations to integrate physician compensation earned from all sources, review dollars paid and balances due, facilitate settlement reporting, project year-end results, model improvement scenarios and generate accruals for Finance.

“With this automated new functionality, health care organizations can significantly reduce manual intervention and potential for human error when managing important pay adjustments for a large clinical workforce. Not only does this help to free up administrators to work on more critical projects, but it also helps to ensure data quality and instill greater trust in the reporting process by seamlessly communicating important information straight to payroll for payment,” said Shelly Slowiak, Director, Product Support, Provider Performance Management Technology™

PPMT’s Compensation Management Analytics module plus the new Clinician Pay feature also provides the option to utilize payroll data for settlement processing - allowing for a comprehensive end-to-end solution for processing clinician payments and compensation adjustments.

“To help organizations navigate an increasingly complex and uncertain health care environment, we are continuously refining our product roadmap and enhancing PPMTTM based on the evolving needs of our clients. Clinician Pay is an exciting new addition to the platform and demonstrates our commitment to developing one of the industry’s most innovative clinical compensation and performance management solutions,” said David Schwietz, Chief Information Officer, SullivanCotter.

Designed to address a spectrum of physician, leadership and other key stakeholder needs, PPMTTM 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 Clinician Pay or our entire suite of Provider Performance Management TechnologyTM, 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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


 

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Modern Healthcare | 2020: Annual Executive Compensation Article

SullivanCotter helps to examine how health care organizations are adapting their executive compensation practices in response to COVID-19

As costs surge and revenue declines for health care organizations amidst the COVID-19 pandemic, many are re-evaluating their executive compensation programs as they focus on organization-wide equity, recovery and what lies ahead in such an uncertain environment.

Featured in an August 2020 edition of Modern Healthcare, SullivanCotter's Bruce Greenblatt and Tom Pavlik share data from SullivanCotter's recent COVID-19 research and highlight some of the key executive compensation changes being implemented or considered in response. This includes actions on base salaries, adjustments to current year incentives to account for the impact of the pandemic, and adjustments to future compensation programs and talent strategies to incorporate recovery considerations and ongoing uncertainty.

In order to focus on the need for financial sustainability, cost efficiencies and revenue growth, all of which have been accelerated by COVID-19, organizations should adopt a more flexible and fluid approach as they move into 2021 and beyond.

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PRESS RELEASE | SullivanCotter Launches Suite of Health Care Benchmarking Solutions

SullivanCotter Launches Innovative Suite of Products to Help Benchmark Health Care Workforce Compensation and Clinical Productivity

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July 30, 2020 – Chicago – SullivanCotter, the nation's leading independent consulting firm in the assessment and development of total rewards programs and workforce solutions for the health care industry and not-for-profit sector, is pleased to announce the launch of Benchmarks360TM. Powered by SullivanCotter's proprietary survey data and research, Benchmarks360TM is a suite of intelligent, web-based products that enables health care organizations to analyze and visualize workforce compensation and clinical productivity.

Designed to address enterprise-wide benchmarking needs for employees at all levels – including executives, physicians, advanced practice providers and other clinical and non-clinical staff positions – Benchmarks360TM provides critical industry-leading data, analyses and reporting to support the compensation decision-making process in an increasingly complex operating environment.

"Amidst a rapidly evolving global pandemic, hospitals and health systems are struggling to navigate a number of unprecedented financial and workforce challenges. Strengthening compensation practices and clinical workforce productivity through unique, data-driven intelligence and insights can help to support long-term sustainability in today's ever-changing marketplace. With the ability to conduct a wide variety of quantitative reviews and custom benchmarking analyses, Benchmarks360TM allows organizations to interactively assess clinical productivity and changes in compensation against national market data," said David Schwietz, Chief Information Officer, SullivanCotter.

As one of the most comprehensive products of its kind, it includes two distinct modules to help balance pay and clinical productivity across the organization:

Workforce Compensation and Clinical Productivity Manager

Compare your organization's compensation and clinical productivity benchmarks to the nation's largest health systems and medical groups. Utilize SullivanCotter's proprietary benchmarking information, representing over one million total incumbents, along with other third-party data sources. This module comes in both a Standard (offered with the purchase of SullivanCotter survey data) and a Pro version (upgrade available for additional licensing fee).

Clinical CPT Manager

Analyze and measure your organization's Current Procedural Terminology (CPT) coding distribution against national physician and advanced practice provider clinical benchmarks at the specialty, work RVU and CPT level. This module can be purchased and added separately.

Benchmarks360TM is offered exclusively to organizations who purchase SullivanCotter survey reports. To learn more, 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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


Modern Healthcare |
Pandemic May Pound Lopsided Physician Pay Model Into Shape

Will pandemic-driven changes to physician compensation affect pay programs in the long-term?

In the early days of the COVID-19 pandemic, health care organizations were faced with a number of unprecedented challenges as in-person visits were delayed and elective surgeries postponed. Many responded by having to implement pay cuts, furloughs and/or layoffs - and the physician workforce was not immune to these changes.

Featured in a July 2020 edition of Modern Healthcare, SullivanCotter helps to evaluate how these pandemic-driven changes to physician compensation programs may indeed be a sign of more significant long-term changes to come if the current surge in cases and situation continues. Despite consistent year over year increases in total compensation, according to SullivanCotter's Physician Compensation and Productivity Survey, organizations will now need to reassess physician pay models in light of recent events to help maintain operations and support future sustainability.

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SullivanCotter Webinar Series | Care Team Optimization

Hospitals and health systems nationwide continue to face a number of urgent financial and workforce challenges amidst an evolving global pandemic.

As organizations look for ways to increase access and manage recovering patient volumes, transform operations and ensure financial stability, focusing on the optimization of the care delivery team is imperative.


Contact us at info@sullivancotter.com to request the recordings from any of the three sessions.

(*Please note that these webinars are intended for health care provider organizations only)

 

Session 1: Building the Business Case for APP Optimization

Wednesday, August 19 | 12:00pm-12:45pm CT

In order to effectively optimize the care delivery team, organizations must understand both the barriers and keys to success, effective affiliation models, readiness indicators and more. SullivanCotter will also highlight real examples that show significant increases in revenue opportunity and patient visits through enhanced APP utilization.

SESSION 2: Data-Driven Care Model Design and Implementation

Tuesday, August 25 | 1:30pm-2:15pm CT

Designing care models with intention to help support optimization is a critical next step. During this session, SullivanCotter's overview of this process will include insight into redesign opportunities, effective change management, implementation planning and expected outcomes. Case studies will showcase real results tied to increased revenue, productivity, access and engagement.

SESSION 3: Compensation Strategies to Reinforce Optimization

Wednesday, September 2 | 12:00pm-12:45pm CT

In order to ensure lasting change, optimization requires strategic compensation programs to help reinforce care models, achieve organizational goals and drive desired results. This session will address the evolution of APP and team-based compensation models as well as highlight important considerations moving forward. Case studies will focus on the team-based incentive plans for primary care and specialty services.


PRESS RELEASE | Darrell J. Cira Joins Employee Workforce Practice

SullivanCotter Welcomes Nationally Recognized Workforce Rewards
and Career Frameworks Consultant

July 21, 2020 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs and workforce solutions for the health care industry and not-for-profit sector, is pleased to announce the addition of Darrell J. Cira, Principal, to the firm's growing Employee Workforce Practice.

With over 25 years of experience advising large and operationally complex organizations outside of and within health care, pharmaceuticals and other life science industries, Darrell is a nationally recognized workforce rewards and career frameworks thought leader and consultant.

Serving as a trusted partner for hospitals and health systems nationwide, Darrell specializes in the design of broad-based employee total rewards programs and talent development strategies to help organizations grow sustainably, achieve key goals and drive performance.

"The industry continues to face unprecedented financial and workforce challenges due to the COVID-19 pandemic, and many organizations are re-evaluating certain policies and practices in light of these recent events. Developing enterprise-wide rewards philosophy, career architecture and compensation frameworks to maintain employee engagement, manage costs and ensure future sustainability is now more critical than ever. Leveraging many years of direct experience within both general industry and health care, Darrell will work with clients to devise and implement strategic workforce programs as the health care industry makes plans for financial recovery and operational transformation," said Ted Chien, President and Chief Executive Officer, SullivanCotter.

Darrell also has an extensive range of additional expertise that will help him to provide greater value for clients in a rapidly evolving health care environment. This includes creating job and compensation infrastructures in the context of today's cloud-based human capital management systems, managing complex compensation plan integrations for a variety of mergers and acquisitions, and conducting pay equity analysis and implementing programs to help address related issues and discrepancies.

Prior to joining SullivanCotter, Darrell spent many years as a partner at a large global consulting firm where he led a number of critical workforce rewards and talent management initiatives.

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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.

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WEBINAR RECORDING | How COVID-19 Has Changed the Utilization and Deployment of Advanced Practice Providers

Cutting Edge Issues and Trends in Health Care Fair Market Value

Webinar from the American Health Law Association which features SullivanCotter's Trish Anen discussing the impact of COVID-19 on advanced practice provider (APP) utilization, deployment and compensation strategies.

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Length: 90 minutes
Level of Difficulty: Advanced
Price: $149

Description: Historically, physicians were the sole clinical provider for most patients across the country. Over the past few decades, the rise of nurse practitioners, nurse midwives, nurse anesthetists and physician assistants (Advanced Practice Providers or APPs) have expanded the concept of a clinical provider.

The COVID-19 pandemic has required health systems across the country to redeploy APPs in various ways and, as a result, many restrictions regarding APP practice have been waived.  This webinar focuses compensation strategies for these individuals and discussed the long term implications for the effective utilization of APPs.


WEBINAR RECORDING | Designing Transitional Compensation Models During the COVID-19 Pandemic

Cutting Edge Issues and Trends in Health Care Fair Market Value

Webinar from the American Health Law Association which features SullivanCotter's Kim Mobley discussing best practices for addressing COVID-19-related compensation for front line physicians.

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Length: 90 minutes
Level of Difficulty: Advanced
Price: $149

Description: Recently, the government issued blanket Stark waivers and Anti-Kickback guidance related to COVID-19 physician arrangements. This new flexibility is welcome news to hospitals, health systems and other organizations that have been tackling challenging physician contracting, compensation and staffing issues during the COVID-19 pandemic.

In addition to discussing the blanket waivers, the webinar will explore developing best practices for addressing COVID-19 coverage for front-line employed physicians, redeployed employed physicians and physicians providing coverage under exclusive provider arrangements.  Speakers will discuss potential regulatory landmines and fair market value strategies and considerations.


Addressing COVID-19: Key Considerations for the Board Compensation Committee

Enhancing Board Governance of Talent Management and Compensation During COVID-19

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The COVID-19 crisis is impacting not-for-profit hospitals and health systems in a myriad of ways. The crisis is placing an enormous strain on both financial and workforce resources by creating uncertainty regarding current/future revenue, volume, employee safety and job security. The Board Compensation Committee (Committee) serves a critical governance role in the organization’s efforts to navigate uncertainty by advising management on talent risks, supporting a focus on the key success factors to survive and recover from this crisis, and ensuring that - if scrutinized - the executive compensation program reflects best governance practices, given market dynamics and the need for Compensation Committees to move quickly.

Guiding principles for the Committee in these unpredictable times may include:

  • Relying on sound business judgment and discretion in compensation decision-making by considering organizational finances, employee health and safety, broader workforce impacts (e.g., furloughs, layoffs), talent risk and burnout, local and industry market responses and competitive market positioning.
  • Basing decision-making on the organization’s specific circumstances with due consideration of market practice intelligence and optics.
  • Being flexible to adapt to a dynamic and fluid environment that will continue to evolve over the coming months.
  • Considering the organization’s compensation strategy and the short/long-term impact of major changes to the compensation program in response to the crisis.
  • Defining key success factors for managing through this crisis, and anticipating the post-crisis changes to strategic and operating priorities, in preparation for discussions on incentive plans that may no longer have relevance due to the disruption caused by COVID-19.
  • Balancing internal and external perceptions of compensation decisions, especially if the organization is receiving financial assistance and/or implementing furloughs/layoffs, with the need to honor previous compensation commitments.
  • Mitigating any immediate key talent risks while maintaining a long-term focus on talent retention and
    succession planning.
  • Ensuring transparency to the full Board on any compensation actions taken during the crisis.

SUCCESSION PLANNING

If within the Committee’s purview, consider the development of an emergency succession plan that identifies the individuals who can serve as interim replacements for key executives who may require an extended quarantine period or experience severe burnout. It is also important to consider whether the current succession plan requires any changes given the emerging organizational challenges as well as the skill sets and qualifications of the current candidates. The crisis will allow for the identification of individuals who are stepping up and exhibiting leadership, which will help to inform the Committee’s succession planning efforts. Prepare for a longer-term review of the talent strategy that will be needed to adapt to and thrive in the post-COVID-19 environment as strategic priorities shift and operating models change.

COMPENSATION DECISIONS DURING COVID-19

The Committee should consider the competitiveness of total compensation while also evaluating retention risks. This requires a facts-and-circumstances approach when evaluating potential compensation reductions. If a long-service executive’s total compensation is high relative to the market with limited variable compensation, the impact of a salary reduction is much different than in a situation involving a short-service executive with below-market compensation and higher variable pay (with incentives unlikely to be paid).

Consider market intelligence on COVID-19-related compensation practices of similarly-situated organizations. To date, the not-for-profit health care sector’s actions related to temporary executive salary reductions, increased deferrals and salary freezes have been modest compared to the more aggressive approach of publicly-held companies. These practices are subject to change as financial challenges increase and the impact on the health care workforce continues to evolve.

A major focus area for the Committee is the annual incentive plan given the economic uncertainty facing hospitals and health systems. Since incentive plans can be helpful in focusing executives on key priorities, rather than suspending or eliminating the plan, give consideration to a more discretionary and flexible approach to performance measurement. This may include re-setting goals, assessing performance pre- and post-COVID response, eliminating irrelevant goals, and/or including measures that focus on restarting the organization and near-term recovery. If utilizing a discretionary approach, guiding principles should be established to help inform decision-making. In some cases, the Committee would be well-served to delay the finalization of incentive measures and goals for forthcoming incentive plans until there is less organizational and market uncertainty. The timing of the conclusion of the performance period will impact the Committee’s options. Those with calendar year-ends may have more time to plan.

While most organizations have not taken any action to date regarding long-term incentive plans (LTIPs), we expect that, similar to annual incentive plans, the negative financial impact and potential reassessment of strategic plans will impact future goal setting and LTIPs that are already in place. As some organizations are considering postponing the implementation of new LTIP cycles, most are waiting until the crisis starts to subside before making any decisions on these plans.

Given the number of new and emerging financial challenges, the Committee should explore actions that will help to control costs without creating significant talent retention risks or sending unintended messages to the workforce. In addition, such actions need to be assessed in light of any implications related to employment agreements and 457(f) and 409A deferred compensation rules.

If your organization is considering loans and loan guarantees available under the CARES Act or the Main Street Lending Program (as available to not-for-profits), assess the required compensation restrictions and their implications for executive and physician recruitment and retention for individuals with CY 2019 total compensation exceeding $425,000.

ACTIONS FOR ENHANCING RECOVERY POST-COVID-19

After addressing issues requiring immediate attention, the Committee should consider actions for enhancing organizational recovery. The definition of performance in the new environment post-crisis continues to evolve, and it may be appropriate to refine the way organizational and individual performance is assessed. The Committee should work with management to define both short and long-term goals required to support recovery (e.g., cost reductions, financial stability, workforce engagement, care redesign) and, if appropriate, include these in incentive plans. Given changes in the delivery model, it may be time to assess organizational structure, spans of control and the scope and definition of various executive roles. Underlying all these actions is the need to identify critical talent and update succession plans and talent management strategies.

COMPENSATION COMMITTEE GOVERNANCE

The Committee should review approval procedures and processes and modify if necessary to ensure critical executive and physician compensation arrangements can be acted upon in a timely fashion. The Committee should consider adjusting its calendar to include more regular discussions on compensation and talent implications over the coming months since the environment is dynamic and circumstances are rapidly changing. If virtual Committee meetings are being considered for the first time, the General Counsel should ensure the desired method is acceptable under state law.

PHYSICIAN COMPENSATION

The Committee should review approval procedures and processes and modify if necessary to ensure critical executive and physician compensation arrangements can be acted upon in a timely fashion. The Committee should consider adjusting its calendar to include more regular discussions on compensation and talent implications over the coming months since the environment is dynamic and circumstances are rapidly changing. If virtual Committee meetings are being considered for the first time, the General Counsel should ensure the desired method is acceptable under state law.

MOVING FORWARD

Although the future is uncertain, an active and focused Compensation Committee will help to ensure that the organization can retain, manage and develop highly effective individuals for key roles who can lead the way in the post-crisis world. The market dynamics around executive compensation are very fluid. Any major program design changes should be carefully considered before implementation as this may impact leadership retention, recruitment and succession planning initiatives in an environment where exceptional health care leaders will be highly sought after.


PRESS RELEASE | SullivanCotter Welcomes Health Care Industry Consultant Russell L. Wilson

Leveraging more than 12 years of industry insight and first-hand knowledge of the evolving health care environment

March 17, 2020 – Chicago – SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs and workforce solutions for the health care industry and not-for-profit sector, welcomes new Principal Russell L. Wilson to the firm’s Executive Workforce Practice.

Russell is an industry expert with over 12 years of experience in advising leading health care organizations on key issues in talent management and total rewards. Leveraging this deep insight and first-hand knowledge of the evolving health care environment, Russell leads a number of client consulting teams in the development of executive compensation strategies designed to drive performance and enhance organizational outcomes.

“The role of the health care executive in today’s operating environment is changing as the principles of value-based care continue to take shape. To help advance key system-wide objectives, leadership is now tasked with developing targeted approaches to improving quality, outcomes and performance across the entire care continuum. Designing integrated talent management and total rewards strategies to support these goals is critical, and Russell will play a vital role as a trusted advisor in helping our clients to implement customized programs aligned with their mission, vision and values,” said Ted Chien, President and CEO, SullivanCotter.

As a member of the firm’s Executive Workforce Practice, Russell works closely with hospitals, health systems and medical groups nationwide to develop long-standing relationships and understand organizational needs and objectives in the ever-changing marketplace. He specializes in aligning executive pay and performance, including short- and long-term incentive plans, with an organization’s strategic initiatives and advises on implementation to help ensure the delivery of competitive and sustainable workforce solutions. Russell also works directly with boards and compensation committees to provide education on best practices for effective and compliant executive compensation approaches, decision-making processes and governance procedures.

Prior to joining SullivanCotter, Russell served as a senior director at global consulting firm where he led talent and rewards for the Health Care Provider National Industry Team.

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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.

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2021 Evaluation and Management CPT Codes

Understanding the Impact on Physician Compensation

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Updated: February 2021


RELATED CONTENT:
INFOGRAPHIC | Considerations for Addressing the 2021 E&M Work RVU Changes
SullivanCotter's CPT Advisory Services and Technology Solutions


Every year, the Centers for Medicare and Medicaid Services (CMS) evaluates the recommendations of the American Medical Association’s (AMA) Relative Value System Update Committee (RUC) and conducts its own review of the Work Relative Value Unit (wRVU) values associated with each Current Procedural Terminology (CPT) code to determine if wRVU 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 values are adjusted. CMS has issued the 2021 Physician Fee Schedule final rule and has significantly overhauled the Evaluation and Management (E&M) code documentation requirements, time-effort recognition, and wRVU values for face-to-face new and established patient office visits. These changes were effective as of January 1, 2021.

Many physicians provide office-based E&M services and, when broad changes such as this occur, the resulting impact can be significant. This article will address:

  • CMS efforts to recognize increased work effort for office visits as well as a summary of the 2021 changes to E&M codes.
  • The reimbursement impact on Medicare physician services as well as the likely downstream effect on commercial payer physician reimbursement.
  • The potential impact on physician and advanced practice provider (APP) reported productivity levels for various specialties.
  • The potential unintended impact on compensation arrangements – especially wRVU production-based plans or salary-based plans with wRVU-based performance measures.
  • Other variables that could influence the assessment of your organization’s wRVU productivity.

PHYSICIAN AND APP WORK RESPONSIBILITIES FOR E&M OFFICE PATIENT VISITS

“Patients Over Paperwork” is a CMS initiative based on the AMA’s RUC recommendations. The goal of this initiative is to reduce burdensome regulations, enhance efficiency and improve the physician experience. The E&M review and adjustments are steps towards removing regulatory obstacles that impede a clinician’s ability to spend time with patients. The first wave of this initiative includes the modification of ten E&M codes used for billing new and established office-based patient visits (codes 99201-99215). Other E&M code groupings (inpatient, skilled nursing, etc.) will be reviewed at a future date.

Several factors were considered when formulating the 2021 changes including:

  • To maintain the “Patients Over Paperwork” goal, CMS kept the documentation reduction requirement for
    appropriate coding.

    • CMS estimates that these adjustments will save 180 hours of paperwork for physicians annually.
  • A time study commissioned by CMS determined that, due to the added responsibilities physicians have experienced over the last five years, an increase in wRVUs for many E&M codes is justified. These include:
    • Longer patient face-to-face time during visits.
    • Increased non-patient time responsibilities such as Electronic Medical Record (EMR) documentation.
    • Added non-reimbursed physician time to coordinate team-based care and population management.
  • To recognize the occasional extended time patient visit, CMS incorporated an add-on code (G2212) for every 15 minutes of additional work effort beyond the time expectation associated with codes 99205 and 99215.
    • This extended time method is similar to anesthesiology work value measurement that credits added time units along with the base procedure.
  • Implementation of another add-on code (G2211) has been deferred until January 1, 2024.  At that time, an add-on code will be available to provide additional recognition (reimbursement and wRVU credit) for qualified, severe, or complex chronic patient conditions.

These adjustments, along with CMS quality incentive payments, signify CMS’ increased recognition of how the process of delivering high-quality health care has changed. The impact of these changes will result in material increases in reported wRVU productivity for office-based specialties. Table 1 below compares the 2020 and 2021 E&M code time allocation and wRVUs.

Table 1: Time Allocations and wRVUs Adjustments: Current versus 2021

THREE IMPORTANT POTENTIAL IMPACTS TO PHYSICIAN PRODUCTIVITY LEVELS AND RESULTING COMPENSATION AND BENCHMARK MEASUREMENTS

1. How will the 2021 wRVU changes impact the measurement of physician productivity?

This is often the first question that arises when organizations try to assess how wRVU changes will impact reported productivity internally, but also when comparing to published national survey benchmarks. To help analyze the impact, SullivanCotter utilized its proprietary database consisting of individual CPT code volumes and modifiers for approximately 20,000 physicians across 100 different specialties. We recalculated two versions of wRVU productivity for comparison: one based on the 2020 wRVU values, and one based on the new 2021 wRVU values. By keeping volumes and distribution constant, the change in reported wRVU productivity is entirely due to the 2021 wRVU adjustments.

Summary findings indicate that of the 100 specialties reviewed, wRVU benchmarks for 46 specialties increased between 3% and 11%. The modeling shows that wRVU benchmarks for an additional 25 specialties increased by greater than 11%. Table 2 below shows the resulting impact on reported wRVUs by number of specialties. This represents a significant change to wRVU benchmarks, and it will be important for organizations to understand the impact on physician compensation and physician practice economics.

Table 2: Overall Specialty Impact of 2021 E&M Changes

Table 3 below illustrates a sample of some of the individual specialties with notable increases to reported wRVUs.

Table 3: Median wRVU Impact of 2021 E&M wRVU Changes

2. How will wRVU changes impact physician compensation benchmarks?

The answer to this question depends on the structure of an organization’s compensation program. If a plan is based heavily on historical compensation per wRVU benchmarks, there will be, all this being equal, an immediate increase in the amount of compensation paid to physicians as a result of the change in wRVU values. According to SullivanCotter’s 2020 Physician Compensation and Productivity Survey, nearly 3/4 of organizations indicated that wRVU productivity drives more than 50% of physician total cash compensation. Conversely, physicians with salary-based plans linked to national compensation benchmarks will not experience an immediate increase in compensation but may experience a change over time as benchmarks evolve.

Over 95% of the organizations participating in the survey utilize national benchmarks to determine annual salaries and/or compensation per wRVU rates. Understanding how to use these benchmarks appropriately is/will be important during the 2021 and 2022 transition years.

SullivanCotter reviewed several different compensation methodologies to estimate the potential impact to survey benchmarks. Considering the E&M code wRVU changes and assuming no modifications are made to compensation plan methodologies we estimate average clinical compensation will increase by approximately 6% assuming no changes in compensation rates is made. This analysis does not include implications from other market factors such as demand, inflation, cost-of-living, changes in productivity and more. As with reported wRVUs, this impact will vary significantly by specialty. Table 4 below highlights the estimated changes to survey benchmarks. See Column A to find the estimated change in compensation.

If an organization utilizes wRVU productivity targets to determine compensation using the 2020 survey data while calculating wRVUs using the 2021 wRVU schedule, this will result in higher compensation as physicians meet or exceed the production targets at an increased rate.

Similarly, if an organization uses the 2020 compensation per wRVU survey benchmark while using the CMS 2021 values to calculate physician productivity, clinical compensation will increase as a result of using compensation per wRVU rates calculated on the older (lower) wRVU values. Using Internal Medicine as an example, the following graph represents the potential unintended consequences for organizations using a variety of compensation plan designs assuming no change in compensation plan methodology. The potential impact varies significantly depending on whether an organization primarily utilizes a wRVU incentive plan versus a salary-based plan.

To avoid these pitfalls, organizations should conduct a strategic review of the 2021 Physician Fee Schedule changes to determine the impact on their physician compensation plans. Considerations include awareness, appropriateness, affordability and feasibility of modifications as well as physician expectations regarding any potential change in compensation.

3. If organizations utilize compensation per wRVU benchmarks, what should they expect with regard to the 2021 survey benchmarks?

As mentioned above, nearly 75% of organizations in the SullivanCotter 2020 Physician Compensation and Productivity Survey utilize the compensation per wRVU benchmark in determining physician compensation. For any organization using the 2021 wRVU values in their compensation plan, a fundamental understanding of how market benchmarks will change is important.

In this article, we reviewed estimated increases to both wRVUs and clinical compensation. However, because the expected change in wRVU values exceeds the expected change in clinical compensation, compensation per wRVU ratios are expected to decrease in future surveys. See Column C in Table 4 for the estimated impact on specific specialties. Overall, our study indicated a 3% decrease in the TCC per wRVU rate, but with significant variability by specialty.

 

OTHER FACTORS TO CONSIDER WHEN ANALYZING COMPENSATION IMPACTS

As organizations continue to evaluate the impact of the final rule during this industry transition, there are several other factors to consider. These include:

  • Will moving forward with historical compensation per wRVU rates and 2021 wRVU values unintentionally create Fair Market Value (FMV) and Commercial Reasonableness (CR) risks due to the resulting higher compensation payments?
  • Do compensation incentive plans include supervisory payments to physicians based on APP productivity levels? The 2021 wRVU value changes will also affect codes utilized by APPs.
  • For specialties that are paid shift rates, are there additional incentive opportunities based on wRVU productivity?
  • Does the organization pay for physician virtual care visits by tying them to office visit E&M values? This could result in unintended higher pay for virtual care.
  • CMS has added G2212 as an add-on code intended to be used with 99205 and 99215 for each additional 15 minutes above 70 minutes of documented time associated with an individual patient visit. The assumptions and analysis above do not account for changes in the distribution of E&M coding or increases in reported wRVU productivity due to this new code. A wRVU increase does not automatically equate to an equal reimbursement increase.
  • CMS also applied an annual budget neutrality factor which caps overall physician fee schedule reimbursement to avoid a significant increase in CMS payments. The reduction in the CMS conversion factor, in combination with significant increases in wRVUs for cognitive specialties, may result in additional compensation paid to physicians. However, revenue increases are unlikely to offset the more significant increases in wRVU-based compensation if 2021 E&M code values and historical compensation per wRVU rates are utilized going forward.

The published 2021 Physician Fee Schedule final rule reduced the Medicare conversion factor by 10.2% to maintain statutorily required budget neutrality. However, on December 27, 2020, the Consolidated Appropriations Act of 2021 – including provisions that temporarily mitigate a portion of the conversion factor reduction – was signed into law. The CMS final rule tables were later published with the 2021 Medicare conversion factor set at $34.89. This is a reduction of 3.3% from 2020. However, expected Medicare revenue increases resulting from the combination of higher RVU values and a higher than anticipated conversion factor rate, are unlikely to offset the more significant increases in wRVU-based physician compensation absent any change in compensation plan rates going forward.

 


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

 


APP Compensation Programs Shifting to Address Growing Market Demand and Changing Models of Care

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February 4, 2020 – Chicago –SullivanCotter, the nation's leading independent consulting firm in the assessment and development of rewards programs and workforce solutions for the health care industry and not-for-profit sector, recently released survey results indicating that advanced practice provider (APP) compensation programs continue to evolve as organizations recognize the roles APPs play in helping to achieve key organizational goals.

There are a number of key factors driving this shift in APP compensation and pay practices, including (1) the increased integration and utilization of APPs to help enhance access, quality, service and affordability in a value-based health care environment; (2) a need for APPs amidst a growing physician shortage; (3) clinical integration and new team-based models of care, which suggest a potential need for greater alignment between physician and APP rewards strategies and; (4) the rising prevalence of APP leadership positions and structures to support the effective management of this rapidly expanding workforceMany organizations are restructuring their pay programs accordingly as ongoing challenges in recruiting, retaining and engaging key APP talent requires a more competitive approach to compensation.

APPs are currently among the fastest growing segments of the health care workforce and, on average, comprise more than one-third of an organization's clinical providers.i As APPs move beyond traditional inpatient and outpatient settings, this growth is driven in part by increased utilization in new and/or emerging practice settings such as urgent care, retail-based and skilled nursing. An analysis of results from SullivanCotter's 2019 Advanced Practice Provider Compensation and Pay Practices Survey confirms the demand for APPs as participating organizations reported significant growth in this workforce. In fact, this growth exceeded yearly estimates by 7%. Similarly, actual increases in base pay continue to outpace expectations. In 2018, the projected average increase was 3.2% compared with an actual average increase of 4.8%. The actual average increase in 2019 was 4%, which is slightly higher than what was projected.

"The strong demand for APPs continues to be a significant trend and can place added pressure on an organization's staffing budget. Actual increases in base pay have been consistently outpacing projections for the past five years, and health care organizations must be mindful of the impact this can have on the bottom line - especially if APPs make up a significant portion of your overall workforce," said Amy Noecker, Principal, SullivanCotter.

As with physicians, APP compensation is evolving to reflect differences between major specialty categories – primary care, medical, surgical and hospital-based. While all categories have seen increases in combined nurse practitioner and physician assistant median total cash compensation (TCC, equal to base salary plus annual incentives) from 2017 to 2019, medical and hospital-based rates have seen the most growth at 5.3% and 5.0%, respectively. Primary care, up 4.6%, and surgical, up 4.4%, follow closely behind.

Additionally, incentives are becoming a component of APP total cash compensation as rewards strategies continue to evolve. Nearly half of participating organizations, at 48%, report utilizing incentive pay for at least some of their APPs. While this prevalence has remained steady year over year, median annual incentive amounts have increased across all specialty categories from 2018-2019. Despite having the lowest overall TCC rates, primary care APPs continue to have the highest reported median annual incentive amounts in 2019 expressed as both a dollar amount, $7,701, and as a percentage of base salary, 6.9%. As in past years, these incentive opportunities are predominantly structured as add-on dollars, 73%, rather than at-risk, 15%.

Clinical integration and the focus on new team-based models of care are also driving the evolution of APP compensation programs. "Although there are still some important differences in the design of physician and APP compensation programs, aligning rewards more closely to ensure complementary versus competitive team-based care delivery is important. As organizations look to establish and reinforce a clinical team-based mindset, many are considering a strategic restructuring of their APP compensation plans to reflect certain elements of physician pay programs," said Trish Anen, Principal and APP Workforce Practice Leader, SullivanCotter.

In 2019, 32% of APP incentive programs contained a team-based component. This prevalence has increased by 5% since 2017. Based on survey responses, most APP incentive plans are relatively simple, with 64% of organizations utilizing just one or two metrics. The most prevalent metrics selected in all practice settings are work RVUs, value/quality-based and patient experience. In an effort to better understand and track impact, the interest in APP productivity continues to grow as more organizations collect and report this information. From 2017-2019, there was a substantial 66% increase in the amount of reported work RVU data and a 26% increase in patient visit data.

Lastly, APP leadership compensation continues to evolve as organizations develop new positions and outline key responsibilities to effectively support the management of this growing workforce. As a result, a clear structure of leadership roles has solidified. In 2019, 58% of organizations reported having designated APP leaders. Of these organizations, 26% utilize a top APP leader. This typically represents one or two leaders dedicated to developing the overall APP workforce strategy. Annual TCC for these top APP leader positions falls between $155,527 and $212,850 (25th-75th percentile) and tends to correlate with the number of employed APPs.

SullivanCotter's 2019 Advanced Practice Provider Compensation and Pay Practices Survey Report  is now in its 8th year. With data from more than 560 organizations on nearly 74,000 individual APPs, this survey provides critical information on physician assistants, nurse practitioners and other certified providers across 127 different specialties. The survey includes insight into base salary, TCC, productivity, incentive plan design and other pay practices such as extra shifts, on-call pay, shift differentials, recruitment and retention bonuses, and more. For more information on SullivanCotter's surveys, please visit our website at www.sullivancotter.com or contact us by phone at 888.739.7039.

Don't miss your chance to participate! The 2020 Advanced Practice Provider Compensation and Pay Practices Survey is now open for submission.

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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


iSource: SullivanCotter 2019 Organizational Characteristics Database
Clinical provider includes: nurse practitioner, physician assistant, certified registered nurse anesthetist, certified nurse midwife, doctor of medicine and doctor of osteopathic medicine

PRESS RELEASE | Physician Compensation Evolving to Address Complex Operating Environment

Results from SullivanCotter's 2019 Physician Compensation and Productivity Survey

December 3, 2019 – Chicago – SullivanCotter, the nation's leading independent consulting firm in the assessment and development of rewards programs and workforce solutions for the health care industry and not-for-profit sector, recently released survey results indicating that physician compensation programs are evolving as organizations address a variety of new challenges in a rapidly changing health care environment.

Some of the key environmental factors driving the need for new approaches to physician compensation and performance programs include (1) new models of care focusing on population health, supporting the transition from volume to value, and enhancing access, quality, service and affordability; (2) a growing demand for key talent amidst a looming shortage of physicians, resulting in a more competitive labor market; (3) aligning physician performance with overall organizational goals; and (4) developing physician compensation plans that are ready to address the challenges associated with CMS quality programs such as MIPS and potential changes to the Stark Law.

An analysis of the survey data indicates that market supply and demand for physicians continues to drive increases in total cash compensation (TCC, equal to base salary plus annual incentives) as organizations look to remain competitive amidst talent shortages. There is a continued year over year increase in median TCC across all major specialty categories – including primary care, hospital-based, medical and surgical specialties. This has been the case for the past ten years.

Despite increases in TCC across the board for these major specialty categories, productivity remains relatively flat and in many cases is even declining. From 2014-2019, median TCC for primary care physicians increased by 14.7%, whereas work RVU (wRVU) productivity declined by 0.2%. As organizations look to expand their primary care providers, there is upward pressure on family medicine and internal medicine compensation without significant changes in wRVU productivity. To meet population health goals, organizations are adding other measures of performance such as panel management and telehealth to their primary care scorecards. Over the same 5-year time period, hospital-based physicians saw the largest growth in median wRVU productivity at 5.2%. This was the only major specialty group to see an increase greater than 1.5%.

"With growing concerns regarding provider supply and demand, organizations are evolving their compensation programs to align with an increasingly competitive talent market. With a looming physician shortage placing pressure on organizational recruitment and retention strategies, this demand continues to push physician compensation upwards without being supported by corresponding gains in productivity or reimbursement – resulting in higher levels of organizational investment per physician," said Dave Hesselink, Principal, SullivanCotter.

Additionally, from 2018 to 2019 the prevalence of value-based incentives, which rewards performance on measures such as clinical quality, patient experience and access, has increased by 5-7% across all four major specialty categories. For primary care, the prevalence of value-based incentive components in plan design was up 5% from last year, with 62% of organizations incorporating these incentives into their physician compensation programs. Medical, surgical and hospital-based specialties all fell in the range of 55-57%.

"While reimbursement models continue to evolve and organizations are focused on incorporating more value-based components into their physician compensation programs, it is important to note that quality incentive payments still only comprise a small portion of TCC. We expect to see continued growth in value-based incentives as organizations work to further develop and refine these programs to ensure they have credible measurement and reporting systems in place before moving forward," said Mark Ryberg, Principal, SullivanCotter.

The actual amounts paid for value-based performance remain relatively small at 6.2% of TCC across all specialties at the median. However, this is up from 5.6% in 2018. Primary care is highest at 7.0% of TCC with hospital-based specialties following at 6.3% and medical and surgical specialties at just below 6.0%.

SullivanCotter's 2019 Physician Compensation and Productivity Survey is now in its 27th year. With data from nearly 700 organizations on more than 206,000 individual physicians and advanced practice providers (APPs), this survey is the largest and most comprehensive dataset of its kind. It provides insight into base salary, TCC and productivity data and ratios including wRVUs, collections, patient visits and panel sizes. For more information on SullivanCotter's surveys, please visit our website at www.sullivancotter.com or contact us by phone 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 and expertise to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.

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PODCAST | Executive Compensation Committee Update

Tim Cotter featured in McDermott Will & Emery's Governing Health Podcast Series

LISTEN TO PODCAST

Health care continues to evolve at a rapid pace, and executives with the skills and competencies to navigate complex change and lead transformation are in high demand. As a result, boards of directors are increasingly focused on the supervision, compensation and retention of the senior executive leadership team.

In this episode, the first in a two-part series, Michael Peregrine welcomes Tim Cotter, Chairman and Managing Director of SullivanCotter, and Ralph DeJong, Partner at McDermott Will & Emery, for a discussion on the latest trends and developments impacting the executive compensation committee's decision-making process.

This episode includes a discussion of the following:

  • Where health care executive compensation is trending in 2020
  • Impact of today's high CEO turnover on board oversight standards and talent retention practices in health care
  • How coordination between the executive compensation committee and other board-level committees is increasing
  • Impact of certain environmental factors on health care executive compensation decisions