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!


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


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.

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


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.


HFMA | Navigating Change: Implications of CMS's 2021 Physician Fee Schedule

Addressing the impact on physician compensation and productivity

Featured in HFMA's Financial Sustainability publication, SullivanCotter discusses changes to the 2021 Physician Fee Schedule and highlights challenges health care organizations and their financial leaders are facing as they look to address the impact on physician and advanced practice provider compensation and productivity.

Due to the magnitude of the changes within the final rule for the 2021 Physician Fee Schedule, organizations with productivity-based physician compensation plans must understand the implications of these changes and on payer payments, productivity levels, survey benchmarks and regulatory compliance.

Learn more about the short- and long-term impact of the changes and different approaches to consider as you move forward with 2021 compensation decisions.


INFOGRAPHIC | 2020 Advanced Practice Provider Compensation and Pay Practices Survey

Representing nearly 20% of all practicing APPs nationwide

Advanced practice provider (APP) compensation programs are shifting to address changing market dynamics and mitigate the financial implications of COVID-19. Considering the current impact of the pandemic, the 2020 survey represents the best data reference point for use in the near future and can serve as a foundation for understanding specialty market positioning leading into COVID-19, pinpointing areas of focus for targeted compensation adjustments, and assisting with post-pandemic budget and productivity planning.

SullivanCotter’s 2020 APP Compensation and Pay Practices Survey contains data from nearly 700 organizations on over 84,500 individual APPs and represents nearly 20% of all practicing APPs nationwide. New in 2020, the survey now also reports expanded work effort data for specialty-based APPs, CRNA-specific pay practices and additional productivity data.

The 2021 survey is now open for participation. Don't miss your chance to submit data and gain access to exclusive APP compensation, pay practices and productivity data!

View highlights from the 2020 results to learn more - including base salary and total cash compensation, incentive compensation, premium pay and clinical productivity.


INFOGRAPHIC | Benchmarking Resources for the Medical Group Workforce

Gain access to critical medical group benchmarking data for the entire health care workforce - including executives, physicians, advanced practice providers and other health care staff

This year more than ever, medical groups require access to critical data-driven insights as they look to address the impact of COVID-19 on workforce compensation and productivity, prepare for the 2021 Physician Fee Schedule changes, and balance the need for competitive total reward programs against pressure on operating margins.

Learn more about SullivanCotter’s growing suite of medical group benchmarking resources for all your workforce needs – including annual compensation data and incentive award opportunities for executives, detailed productivity reporting for physicians and advanced practice providers, and market data by organization size, region, state and more for other health care staff positions.

Our suite of 2021 health care compensation surveys are now open for participation! 

View highlights from the 2020 results to learn more about SullivanCotter's proprietary benchmarking data and resources available to medical groups.




INFOGRAPHIC | 2020 Physician On-Call and Telemedicine Compensation Survey

One-of-a-kind survey providing rare insight into physician call-pay and telemedicine practices

As clinical care settings and practices continue to change in a rapidly evolving health care environment, many organizations are expanding or evaluating their physician on-call and telemedicine programs.

Designing effective arrangements to support this demand is critical, and starts with gaining access to the right data.

With nearly 300 participating organizations providing information on approximately 3,100 individual call contracts, this survey provides hospitals and health systems with the data they need to help address complex call pay issues, understand emerging trends in telemedicine, negotiate contracts and evaluate physician fair market value.

The 2020 survey report is now available for purchase! View highlights from the results to learn more.


ARTICLE | 10 Best Practices for the Board's Human Capital Committee

Featured in McDermott Will & Emery's new e-book from its Governing Health series

SullivanCotter's Kathy Hastings, Executive Workforce Practice Leader, and Tim Cotter, Manging Director, have contributed to a new e-book from McDermott Will & Emery entitled Key Agenda Items for Board Committees: A Briefing for Governance and Executive Leadership.

Their chapter focuses on the board human capital committee and the key role it plays in guiding human resources strategies as health care organizations face today's challenges. Human capital is critical to organizational strategy, and the committee should test whether the components of the human capital strategy – namely people, process and technology practices – can sustain the organization.



INFOGRAPHIC | 2020 Endowment and Foundation Investment Staff Compensation Survey

Featuring data from more than 50 not-for-profit organizations nationwide

This survey offers a comprehensive look into compensation and pay practices for investment staff positions among college and university endowments, private foundations, health care and other not-for-profit organizations. It also includes detailed insight into the chief investment officer position.

View highlights from the 2020 results, including average year-over-year increase in base salary for key investment positions, incentive compensation as a percentage of salary for the chief investment officer position, and investment office size by asset category.

Don't miss your chance to participate - the 2021 survey is now open! The final deadline to submit is February 26, 2021.


Understanding Co-Management Arrangements

Key drivers, compensation structures and payouts, and performance metrics and target setting

As health care continues to shift its focus from volume to value, hospitals are implementing strategies to help strengthen hospital-physician alignment. Co-management arrangements are contractual agreements between hospitals and physicians that establish shared responsibility for particular service lines. These agreements are commonly structured with an even split between both base and incentive compensation components. Base compensation is tied to the number of management service hours required to fulfill baseline duties, while incentive compensation is linked to strategic performance measures.


INFOGRAPHIC | 2020 Health Care Staff Compensation Survey

Key considerations for the health care employee workforce during COVID-19 and through 2021 and beyond

Employee compensation programs are shifting to address changing market dynamics and mitigate the financial implications of COVID-19. Considering the current impact of the pandemic, the 2020 survey benchmarks represent the best data reference point for use in the near future.

Organizations have been impacted by the pandemic to varying degrees, so it is important that each organization analyzes their unique circumstances when utilizing this market data. Applying a holistic approach will allow each organization to consider future changes that are the best fit for their situation rather than an industry best practice.

SullivanCotter’s 2020 Health Care Staff Compensation Survey contains data from nearly 1,200 organizations on approximately 1,194,900 individual employees.

The 2021 survey is now open for participation!


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, 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.


INFOGRAPHIC | 2020 Physician Compensation and Productivity Survey

Utilizing the 2020 survey data to assess the competitiveness of physician compensation programs and incentive opportunities

Physician compensation programs are shifting to address changing market dynamics and mitigate the financial implications of COVID-19. Considering the current impact of the pandemic and the impending wRVU changes in
2021, the 2020 survey 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 you move forward with 2021 planning.

Learn more from SullivanCotter’s 2020 Physician Compensation and Productivity Survey - which contains data from more than 800 organizations on approximately 244,000 individual physicians and advanced practice providers (APPs).

The 2021 survey is now open for participation!


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, 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.


business meeting with charts and data graphics overlay

INFOGRAPHIC | 2020 Manager and Executive Compensation in Hospitals and Health Systems

Considerations for using the 2020 survey data in light of COVID-19

As the last set of benchmark data available prior to the onset of COVID-19, SullivanCotter shares results from its 2020 Manager and Executive Compensation in Hospitals and Health Systems Survey. This analysis also includes insight into pandemic-related pay actions, important considerations for 2020 and beyond as organizations plan for what lies ahead, and using this year's benchmark data to help navigate future executive compensation decisions in light of COVID-19 and other market dynamics.

Now in its 28th year, this survey is the largest and most comprehensive of its kind for hospitals and health systems nationwide. Information was collected from over 2,200 organizations comprising 460 health systems and 1,800 hospitals and includes data for more than 42,000 individual managers and executives.

The 2021 survey is now open for participation!



INFOGRAPHIC | Considerations for Addressing the 2021 E&M Work RVU Changes

Considerations for Addressing CMS' final changes to the 2021 E&M Work RVU Values

ARTICLE | 2021 Evaluation and Management CPT Codes: Understanding the Impact on Physician Compensation
SullivanCotter's CPT Advisory Services and Technology Solutions

Following its annual review of the American Medical Association’s Relative Value System Update Committee’s recommendations, the Centers for Medicare and Medicaid Services (CMS) finalized proposed changes to the 2021 Physician Fee Schedule and has significantly overhauled the Evaluation and Management (E&M) code documentation requirements, time-effort recognition, and wRVU values for new and established patient office visits.  These changes were effective as of January 1, 2021.

As organizations look to understand the impact of these changes on reported physician productivity levels, it is also important to assess the effect it will have on physician compensation arrangements, fair market value and commercial reasonableness considerations, financial sustainability and national survey benchmarks.

Contact us or visit our CPT Solutions page learn more about assessing the impact of the E&M code changes within your organization.


Optimizing Care Delivery in Response to COVID-19

Supporting system-wide alignment in an evolving health care environment


Health systems nationwide continue to face a number of unprecedented challenges due to the evolving COVID-19 pandemic. Supporting financial sustainability remains a top priority. As the industry looks ahead and makes plans for financial recovery and operational transformation, optimizing care delivery to improve efficiency, drive workforce performance and increase revenue is a critical step in this process.

Care delivery optimization between systems and their affiliated hospitals, integrated practices, and physician and advanced practice provider (APP) workforces can promote financial sustainability by identifying gaps in care delivery, improving operational efficiency, reducing clinical variation, and expanding capacity for important growth initiatives. To help accomplish this, there are five key areas that health care organizations should focus on as they look to position themselves to deliver the greatest possible value.

SullivanCotter recommends a thoughtful and strategic review of the following areas:

Physician/APP-Hospital Alignment

Aligning operations, goals and results across the organization is key to building a workforce that is unified and supports organizational strategy. To enhance care delivery optimization, organizations should:

  • Assess current physician affiliation relationships, including pending and/or potential mergers and acquisitions and consider:
    • Updating due diligence assessments in the context of COVID-19 to include financial analysis and review of agreements
    • Reviewing key characteristics of existing compensation arrangements and performance requirements to conduct best practice comparisons by affiliation model/relationship and assure incentives are aligned between the models
  • Evaluate current and projected physician and APP staffing requirements and care team development to address community need, integrated practice and service line needs
  • Review current and potential Service Line Co-Management or HEIP (Hospital Efficiency Improvement Plan) arrangements to ensure the metrics are still aligned with system goals
  • Assess physician involvement in the decision-making process, including medical group and service line governance structure
  • Consider clinical workforce culture and perceptions related to strategic objectives while also identifying opportunities for improvement

Medical Group Operational and Financial Performance

Evaluating a medical group’s overall performance against a variety of operational and financial metrics will help identify actionable areas for improvement.

  • Assess key medical group and/or specialty-level operational and financial performance indicators
    • Review and update productivity thresholds and benchmarks, revenue, expenses and overall financial performance, staffing ratios, measured outcomes, patient capacity and clinic throughput
    • Evaluate performance indicators shared with physicians and APPs and ensure systems are in place to provide transparent and timely information on performance relative to benchmarks, service line and system strategic goals
    • Consider primary care model redesign and develop financial feasibility pro forma based on volume expectations and clinical regulations
    • Focus on care delivery models designed to achieve optimal financial performance with a patient-centric focus (e.g., improves satisfaction, APPs practice at top-of-license, yields appropriate return on investment)
  • Perform workflow assessment at the service line and practice levels to evaluate patient access and throughput, including the utilization of telehealth and remote services

Specialty and Service Line Care Delivery

Once the medical group’s overall performance has been assessed and specific underperforming specialties have been identified, it is important to do a deep dive into specialty and service line performance. Assessing clinical workforce performance is imperative as organizations look to increase the focus on value-based outcomes associated with quality and cost.

  • Evaluate unwarranted care variation and cost-efficiency opportunities
  • Develop strategies to reduce length of stay variance, readmission and value-based care penalties
  • Perform service line and facility-based workforce planning and staffing efficiency assessments
  • Identify appropriate benchmarks related to cost of care against internal and external cohorts
  • Review physician referral processes to help project actual and expected volumes

Readiness for Value-Based Care

Successfully navigating the transition from volume to value relies largely on enhancing patient access. Care model designs that do not support this goal will likely result in stagnant market share or loss of patients.

  • Conduct a physician needs assessment, demographic map and strategic plan to match service needs within market segments based on expected changes
  • Perform analysis of telehealth capacity, financial return on investment and regulatory requirements
  • Assess clinic space, including waiting room access and throughput in light of COVID restrictions

APP Utilization

APPs are one of the fastest growing segments of the health care workforce. Integrating APPs as key members of the care delivery team and utilizing them to their full potential can help an organization to achieve a number of important goals – including improved patient access, increased revenue, and enhanced quality and service while also reducing the cost of care.

  • Perform a current-state analysis by comparing APP utilization and productivity to market benchmarks based on specialty and role:
    • Quantify the financial opportunity available with a fully optimized APP workforce
    • Conduct a readiness assessment to determine barriers and cultural considerations related to full APP optimization
    • Identify specific specialties or service lines with the most opportunity (financial or non-financial) and readiness for change
  • Review and update APP organizational practices:
    • Assess governance structures, recruitment and retention policies, and training and development programs
    • Align organizational bylaws, policies, practices and operations to federal and state laws, payer policies and procedures, and leading market practices


The process of evaluating these five focus areas will help to highlight and quantify opportunities for improving patient access, enhancing organizational efficiency, increasing revenue and reducing costs as health systems plan for what lies ahead. For each area of focus, SullivanCotter recommends developing an in-depth assessment, utilizing operational and financial expertise and incorporating comparative benchmark data analysis to define potential solutions unique to the requirements of each system to help optimize clinical performance and achieve key organizational goals.


Leveraging data-driven insights and over 25 years of experience, SullivanCotter partners with organizations to develop comprehensive care delivery optimization strategies tailored to the unique needs of each client.

Implementing a Job Architecture

Getting the Most from Your Human Capital Management System


A Time of Transformation

Due to the evolving COVID-19 pandemic, hospitals and health systems nationwide continue to navigate a number of financial and workforce challenges. As organizations make plans for financial recovery and operational transformation, there is no doubt that the health care industry is in the midst of significant change. At present, there are many views on the form this transformation may take. Recent news articles and interviews with health system executives suggest a myriad of approaches are likely to be taken during such an unprecedented time:

  • Reducing and/or reallocating certain resources to optimize the workforce
  • Streamlining management structures
  • Accelerating mergers and acquisitions
  • Restructuring/centralizing administrative and patient care services to facilitate innovation and deployment
  • Standardizing processes to more clearly define roles and responsibilities
  • Diversifying health systems through continued entry into adjacent enterprises such as health plans and technology solutions
  • Reimagining and accelerating the delivery of care in ambulatory settings and virtually
  • Broadening skill sets to facilitate flexible deployment and re-deployment of certain workforces in times of change and/or crisis

Although this journey will look different depending on the unique needs and circumstances of individual organizations, change is well underway. Though the health care industry has been evolving for a number of years, COVID-19 has made the need for transformation more urgent and, in some cases, greatly affected the trajectory of the transformation.

Technology and Transformation

To facilitate transformation, many health care organizations are beginning to migrate from on-premise Enterprise Resource Planning (ERP) and Human Capital Management (HCM) systems to cloud-based platforms from organizations such as Workday, SAP, and Oracle/PeopleSoft.1

While the transition has been slow, the need for greater workforce optimization and enhanced processes along with the growing obsolescence of on-premise systems triggered this migration. Organizations making the investment in a cloud-based system report that they are looking to:2

  • Enhance critical workforce insights through real-time reporting and analytics to facilitate workforce optimization
  • Improve administrative processes and implement best practices to allow functions such as finance, supply chain management and human resources to be more strategic
  • Align operations around a single system – eliminating a number of disparate applications
  • Streamline transactions as it relates to mergers, acquisitions and organizational restructuring
  • Integrate a variety of information sources to enhance data integrity
  • Secure best-in-class manager and employee self-service capabilities
  • Support compliance and mitigate risk
  • Reduce variability of practices across the organization

At a time when hospitals and health systems are looking to restructure, diversify and transform, it may seem counterintuitive to suggest that ERP and HCM systems will be a key part of an organization’s transformation strategy. However, David Chou, a prominent health care technology executive and consultant, indicates that “healthcare provider institutions must begin aggressive ERP initiatives” going into 2021 if they want to remain competitive.3 He notes that many on-premise systems are being sunset as the need to enhance the efficiency of administrative processes is long overdue. Health care organizations have only two choices – carry on with costly and inefficient processes or finally make the investment in ERP and HCM technology to optimize and align operations.

For those who play a critical role in managing the health care workforce, the most important component of an ERP system is its HCM module. An HCM system is essentially a database and group of applications that helps to facilitate the management of an organization’s workforce. This often includes compensation, recruitment, learning and development, performance management and payroll functionality. It can either stand alone or be implemented as part of a broader ERP system.

Implementing a Human Capital Management System

Unfortunately, surveys indicate that nearly half of ERP projects fail to achieve the desired outcomes or run over budget and past deadline.4 While there are a number of reasons for these implementation challenges – the most prominent one is that many organizations are simply not ready or properly prepared.

A successful implementation requires much more than just the technology. Critical to the process is a need for well-defined goals, strong commitment from management and other key stakeholders, depth and breadth of expertise on the project team, open communication and the dedication to instill change.

Also very important, but often overlooked, is the need to have clearly defined processes and structures prior to implementation. Foremost, there is little value in implementing structures and processes that are not fully aligned with an organization’s strategy. Additionally, with the tight timeframes often set by organizations and their deployment partners, there is usually little choice but to do what is known as a “lift and shift”. This refers to organizations utilizing their current processes and simply reimplementing those practices into the new technology platform.

This poses a unique challenge for health systems as few organizations begin the deployment with best practices in place. In fact, many utilize a number of disparate processes, structures and tools to manage human capital. So not only have they failed to implement best practices, they currently have few system-wide practices in place.

A comprehensive review of SullivanCotter’s Workforce Insights360™ database, which contains related information from nearly 40 contributing hospitals and health systems, shows that:

  • Approximately 25% of organizations have more than 1,900 job titles and have just 5 employees per job title – this number is even less if you exclude nursing and service line jobs.
  • From CEO to first line supervisor, the median number of organizational levels is 8. The median number of management job levels is 15 – which includes almost 2 management job levels per organizational level.
  • Moreover, 25% of organizations have 20 or more job levels from CEO to supervisor. This level of granularity explains why many organizations have difficulty differentiating management titles and far exceeds the one-to-one relationship between job titles and organizational levels common in other industries.
  • In regards to reporting relationships and the restructuring around functional lines, only about 60% of human resources and finance employees report up through the CHRO or CFO hierarchy. For a quarter of the organizations, this number was less than 50%. This suggests that health care organizations remain largely decentralized when it comes to support functions.

While an HCM system can be implemented without aligning important processes and structures, failure to do so prior to or in conjunction with HCM system deployment often leads to sub-optimal outcomes. Not only is the organization failing to secure the type of transformational change that was likely an important reason for the initial investment in a cloud-based HCM system, but the functionality they are getting as a result is often sub-optimal.

Although highly recommended as an important best practice, it may not be feasible for some organizations implementing an HCM system to have all their processes and structures harmonized and defined at the outset. The implementation of an HCM system is a journey that provides the ability to strengthen and refine current processes and structures or develop new ones.

However, there is one area that all organizations should prioritize – their job architectures.

The Importance of a Job Architecture

Job architecture refers to an organization’s framework for defining and cataloging jobs – the output of which is its library of jobs.

For many HCM systems, the job architecture and database are the hub around which critical functionality is built.

Studies show that 75% of organizations that have implemented a new cloud-based HCM system have also developed a new job architecture before, during or after deployment.5 This not only reinforces how critical a well-defined job architecture is to this process, but also highlights the fact that most organizations do not already have the appropriate structures in place to maximize value from the deployment of a new HCM system.

How an organization defines the job architecture influences how many jobs it has and how the roles are defined. It will affect what type of reporting and analytics are available and how workforce data is accessed by executives, managers and employees. It will also impact how human resources programs are designed or can be deployed. The structure of this database and its content are critical to optimizing the functionality of an HCM system.

The table below reflects the type of information frequently housed in this database and its linkage to important human resources processes:

To optimize the deployment and eventual utilization of the job catalog within a cloud-based HCM system, organizations must consider the following:

1. Cloud-based HCM systems are configurable – not customizable

Hospitals and health systems coming from an on-premise environment are accustomed to doing just about anything they want. When developing new attributes, for instance, they often write elaborate scripts to create custom workarounds. Cloud-based platforms are not intended to work this way, however. They are built upon best practices that the technology provider applies to all users and work best when one understands their parameters and builds their job architecture and job content around those parameters.

2. Manager and employee self-service requires consistency and ease-of-use

Several HCM systems highlight manager and employee self-service as a cornerstone in their value proposition. This creates a challenge for organizations that lack transparency in their job architecture and compensation programs.

If these self-service capabilities are enabled:

  • A simple and intuitive organizing principle must be developed so managers and employees can search, query and request reports
  • Inconsistencies should be resolved to eliminate any potential confusion and enhance the usability of the information
  • Content must be widely available and regularly maintained to allow managers and employees to make appropriate decisions within a self-service environment

Organizations implementing a cloud-based HCM system with manager and employee self-service capabilities would be wise to resolve all of these challenges before going live to help ensure the organization can “hit the ground running.”


If a redesign of an organization’s job architecture is required, it is best to do so before undertaking the HCM system deployment. However, if that is not feasible, developing a new job architecture concurrent with the implementation work is possible and can be done without negatively impacting the implementation schedule.

Organizations that decide to do this should consider the following:

  1. Build your project plan around the milestone dates provided by your deployment partner. These are generally nonnegotiable as the deployment costs are based on meeting these deadlines and any work needs to be completed within this timeframe.
  2. Consider adopting an established job framework. This will help to ensure alignment with the market, reduce the time required to develop the job architecture, and decrease the burden on the human resources team.
  3. Prioritize the work and focus only on what is necessary to accomplish before going live.

For organizations that have already implemented a new HCM system and are seeing the consequences of not having harmonized or rationalized job structures, it can be difficult to know when to do the work. There may be fatigue from having recently gone through a large HCM system implementation or unease regarding additional change. Both are reasonable concerns. If significant change is not possible, organizations may consider modifying the attributes used to organize jobs in the HCM system rather than completely restructuring the job framework and compensation systems. While more significant action may be necessary in the long-term, small or modest changes in the structure of the job catalog can enhance value and functionality.


While some organizations may decide to implement a new cloud-based HCM system simply because they are phasing out their current platforms, most who embark on this journey are looking to secure greater insights in order to optimize their workforces, improve critical support functions and enhance organizational efficiency. Ensuring that best practices, effective internal structures, and technology-enabled processes are in place is the surest path to success.

1As Healthcare Turns to ERP, It Also Turns to the Cloud, Brian Eastwood, HealthTech, November 9, 2018.
2Getting the Most from Workday: It’s Not Just About Configuration. Darrell Cira and Susan Lokker, WorldatWork Training Course, October 2017.
3Don’t Sleep. Healthcare CIOs Must Step Into 2021 Now. David Chou, Forbes, May 21, 2020.
4ERP Software: Facts and Stats, Elizabeth Quirk, ERP Solutions Review, April 18, 2019.
5Hidden Challenges of Implementing a New HRIS on the Total Rewards Function. Darrell Cira, Rob Heir, Patrick Bostrom, Steven Seykora, Presentation at WorldatWork National Conference, May, 2015.

INFOGRAPHIC | APP Leadership Practices and Structures

Leadership Structures to Support Advanced Practice Provider Retention and Engagement

Advanced practice providers (APPs) comprise one of the fastest growing workforces in the United States and are integral to effective and efficient health care delivery.

Organizations are developing APP leadership structures to create comprehensive workforce strategies that focus on APP optimization, workforce planning, recruitment, retention, engagement and ensure alignment with physician workforce strategies.

Learn more from SullivanCotter's 2019 APP Workforce Practices and Structures Survey.