Productivity Measurement & Management- Stepping on the 3 rd Rail of Radiology

Transcription

1 Productivity Measurement & Management- Stepping on the 3 rd Rail of Radiology Lawrence R. Muroff, M.D., FACR CEO & President Imaging Consultants, Inc. 10/3/2017 Lawrence R. Muroff, M.D., FACR 1

2 Disclosure of Commercial Interest I am the CEO & President of Imaging Consultants, Inc. (ICI), a company that provides consulting services to radiology practices, hospitals, and corporate entities. This will not impact the scientific balance of this presentation. 10/3/2017 Lawrence R. Muroff, M.D., FACR 2

3 If it ain t broke, don t fix it! old Southern proverb 10/3/2017 Lawrence R. Muroff, M.D., FACR 3

4 Attempts to measure productivity, reward or punish outliers, and develop fair and equitable practice policies can, at times, be more divisive than the underlying productivity differences themselves. Duszak & Muroff, JACR June and July /3/2017 Lawrence R. Muroff, M.D., FACR 4

5 5 Hypotheticals To Consider 10/3/2017 Lawrence R. Muroff, M.D., FACR 5

6 1) A problematic partner (behavioral issues) is also a low producer in the practice. The group decides that it can deal with both problems at the same time by instituting a productivity management plan that reimburses on the basis of RVU s generated. 10/3/2017 Lawrence R. Muroff, M.D., FACR 6

7 There are two other popular group members who are affected, as they have similar productivity numbers. These popular members are dispirited and stop their practice building activities to focus on increasing their RVU s. What should be done? 10/3/2017 Lawrence R. Muroff, M.D., FACR 7

8 2) A nuclear medicine physician in a hybrid practice (private practice with a teaching program) performs many practice-building activities, including heading the residency program and serving as chair of radiology at one of the practice s hospitals. 10/3/2017 Lawrence R. Muroff, M.D., FACR 8

9 Unfortunately, her productivity is 250% lower than the highest RVU producers, and these 3 high producers are starting to slow down because the group is doing nothing about the low producer. What action (if any) should be taken? What should be an acceptable range between high and low producers? 10/3/2017 Lawrence R. Muroff, M.D., FACR 9

10 3) The interventional radiologists are consistently in the lower third of the RVU production figures that their private practice group distributes each month. They refuse to read any diagnostic studies, even those associated with the cases that they perform. 10/3/2017 Lawrence R. Muroff, M.D., FACR 10

11 On occasion, they are seen in the IR office reading journal articles while they wait for the next case to arrive. What (if anything) should be done? Would this decision be different if they were in the upper third of the group s RVU producers? 10/3/2017 Lawrence R. Muroff, M.D., FACR 11

12 4) A large practice has decided to measure productivity using gross charges, which they state is a rough proxy for RVU production. They believe that generating RVU measurements for each member is too difficult for their billing company. 10/3/2017 Lawrence R. Muroff, M.D., FACR 12

13 Four neuroradiologists are the high charge generators and call themselves the million dollar club. These group members then urge the practice to differentially reward all radiologists based on the charges that they generate. 10/3/2017 Lawrence R. Muroff, M.D., FACR 13

14 The group decides to base 50% of member compensation on charges generated. What would you suggest? If you agree to base compensation on charges generated (or even on RVU s), is 50% too much to put at risk? Is it not enough? 10/3/2017 Lawrence R. Muroff, M.D., FACR 14

15 5) A newly hired business manager is very excited. He has just returned from an RBMA meeting where one of the speakers has extolled the benefits of the compensation plan used by attorneys and accountants. 10/3/2017 Lawrence R. Muroff, M.D., FACR 15

16 The speaker presents a compelling argument for adopting a compensation model for radiologists based solely on productivity. He further opines that this is long overdue. The new business manager presents this idea to the executive committee of the group at their next meeting. What do you think? 10/3/2017 Lawrence R. Muroff, M.D., FACR 16

17 The Problems with Productivity Measurement 1) There are no RVU differences between easy and difficult cases- and the good radiologists typically get a disproportionate share of difficult cases 2) There are no RVU credits given for consulting with referring physicians 10/3/2017 Lawrence R. Muroff, M.D., FACR 17

18 The Problems with Productivity Measurement 3) All RVU s are not alike 4) There may intentionally be sites in the practice that are inefficient (this can sometimes- but not always- be lessened by using PACS) 10/3/2017 Lawrence R. Muroff, M.D., FACR 18

19 The Problems with Productivity Measurement 5) There are no RVU s for practice-building and other administrative chores 6) An emphasis on productivity promotes bad behavior and disincentivizes necessary practice protecting activities 10/3/2017 Lawrence R. Muroff, M.D., FACR 19

20 The Problems with Productivity Measurement 7) Metrics reflect only what they are intended to measure. Thus, the clinical output- RVU (pw)- of a practice member becomes the only way objectively to place a value on the contributions of a particular radiologist in a practice 10/3/2017 Lawrence R. Muroff, M.D., FACR 20

21 Why Measure Productivity? 10/3/2017 Lawrence R. Muroff, M.D., FACR 21

22 Why Measure Productivity? 1) There is a problematic partner/associate whose productivity is low 2) The more productive members are feeling cheated by the less productive members- improve practice morale 3) Other groups are doing it 10/3/2017 Lawrence R. Muroff, M.D., FACR 22

23 Why Measure Productivity? 4) By measuring, we can improve the performance of low outliers 5) ) In order to reward or punish outliers 6) Other members (high producers) are slowing down 10/3/2017 Lawrence R. Muroff, M.D., FACR 23

24 Why Measure Productivity? 7) Productivity measures make hiring decisions more objective 8) You can t manage what you don t measure 10/3/2017 Lawrence R. Muroff, M.D., FACR 24

25 What Should Not Be Measured? 1) Income collected- favors the good pay rotations; also favors cherry picking. Eat- what-you-kill models have been generally destructive to radiology practices 10/3/2017 Lawrence R. Muroff, M.D., FACR 25

26 What Should Not Be Measured? 2) Charges- a rough proxy for RVU s, but not as good as the real thing. Can create disruptive braggers. 3) Procedures- an outdated concept from the plain film era of radiology (chest film MRI biliary diversion) 10/3/2017 Lawrence R. Muroff, M.D., FACR 26

27 What Should Be Measured? RVU s- specifically work RVU s A total RVU is comprised of three components- 1) physician work 2) practice expense 3) malpractice expense RVU(t) =RVU(pw) + RVU(pe) + RVU(me) t = total; pw = physician work; pe = practice expense; me = malpractice expense 10/3/2017 Lawrence R. Muroff, M.D., FACR 27

28 Measuring (pw) RVU s is not enough! 10/3/2017 Lawrence R. Muroff, M.D., FACR 28

29 Establishing and recognizing the value of non-clinical activities is of critical importance 10/3/2017 Lawrence R. Muroff, M.D., FACR 29

30 The Academic RVU (arvu)- A tool to recognize academic productivity and quantify all aspects that are important to an academic radiologist Mezrich and Nagy. JACR /3/2017 Lawrence R. Muroff, M.D., FACR 30

31 arvu = arvu(p) + arvu(c) + arvu(t) + arvu(r) p = publications c = administrative and community service t = teaching r = research 10/3/2017 Lawrence R. Muroff, M.D., FACR 31

32 Can private practice groups implement a measurement that is comparable to the arvu? Doing so would enable recognition of important practice-building activities that are essential to the survival, growth, and continued existence of a radiology practice. 10/3/2017 Lawrence R. Muroff, M.D., FACR 32

33 The non-clinical RVU (ncrvu) A measurement that could be developed by private practices to use in conjunction with clinical RVU tracking. Combining pwrvu s and ncrvu s would enable practices to determine and set expectations for members that were appropriate to the culture of that specific practice. 10/3/2017 Lawrence R. Muroff, M.D., FACR 33

34 ncrvu = RVU(a) + RVU(s) + RVU(q) + RVU(c) a = administrative and leadership s = practice, hospital, and community service q = quality and safety c= citizenship (behavior and attitude) Duszak & Muroff, JACR July /3/2017 Lawrence R. Muroff, M.D., FACR 34

35 The non-clinical RVU is a newly introduced tool and needs to be calibrated and validated in each specific group; however, failure to recognize what it measures can be very problematic to any radiology practice. 10/3/2017 Lawrence R. Muroff, M.D., FACR 35

36 Can you benchmark your practice using national data for comparison purposes? 10/3/2017 Lawrence R. Muroff, M.D., FACR 36

37 If you ve seen one practice, you ve seen one practice. anonymous old, but wise, radiology sage 10/3/2017 Lawrence R. Muroff, M.D., FACR 37

38 Problems with Benchmarking Your Practice Against National Data 1) Literature data is aging rapidly (but unlike good French wine is not aging well); because productivity has been increasing at a significant rate. Furthermore, some data is heterogeneous; while, in my opinion, other data is suspect 10/3/2017 Lawrence R. Muroff, M.D., FACR 38

39 Problems with Benchmarking Your Practice Against National Data 2) Practice cultures differ - days worked per year, length of work day, weekends worked, sub-specialization, etc. 10/3/2017 Lawrence R. Muroff, M.D., FACR 39

40 Problems with Benchmarking Your Practice Against National Data 3) Practice demographics varymodality mix, need for radiologists to travel to different sites, % out-patients versus in-patients, age and condition of patients, age of radiologists in the practice, etc. 10/3/2017 Lawrence R. Muroff, M.D., FACR 40

41 Problems with Benchmarking Your Practice Against National Data 4) Technology varies among practicesuse of VR (with and without editors), PACS, the experience that radiologists have with the technology, etc. 10/3/2017 Lawrence R. Muroff, M.D., FACR 41

42 Economics of Diagnostic Imaging: National Symposium (EDI) data /3/2017 Lawrence R. Muroff, M.D., FACR 42

43 Data collected by the audience response system (ARS) at the 2015 Economics of Diagnostic Imaging: National Symposium (October 2015) 10/3/2017 Lawrence R. Muroff, M.D., FACR 43

44 Does Your Practice Measure Productivity? 1. Yes 2. No 10/3/2017 Lawrence R. Muroff, M.D., FACR 44

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46 Private practice radiologists: How many procedures do you perform/interpret per year? 1. Less than 12k per year k k k k k k 8. > 27 k 9. Don t know 10/3/2017 Lawrence R. Muroff, M.D., FACR 46

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48 Private practice radiologists: How many work RVUs do you generate per year? 1. Less or equal to 10 k k k k k k k 8. > 22 K 9. Don't know 10/3/2017 Lawrence R. Muroff, M.D., FACR 48

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50 What Is the Impact of Subspecialization? In academics, nuclear medicine physicians are low producers; neuro-radiologists are high producers. (5,593 v. 9,688 work RVU) Is this acceptable in hybrid and/or private practices? Probably not to the same extent. Radiologists tend not to tolerate their colleagues sitting around waiting for studies to become available for interpretation. 10/3/2017 Lawrence R. Muroff, M.D., FACR 50

51 Urban Legend- Productivity I m slow because I m careful This is usually said: 1) In response to being asked to speed up (generate more work RVU s) 2) Implying that the more productive members of the practice substitute speed for accuracy 10/3/2017 Lawrence R. Muroff, M.D., FACR 51

52 The Hawthorne Effect Based on observations at the Hawthorne Works (factory) between Workers improve their performance (increase their productivity) if they believe or know that they are being watched 10/3/2017 Lawrence R. Muroff, M.D., FACR 52

53 What Can Be Done with the Data? 1) Watch and hope that the Hawthorne Effect takes hold.- this is what happens in most practices that distribute data 2) Eat-what-you-kill compensation model. As noted earlier, this has been very destructive for most every practice that has tried to implement this model. A few exceptions occur- interventional call; teleradiology companies, etc. 10/3/2017 Lawrence R. Muroff, M.D., FACR 53

54 What Can Be Done with the Data? 3) Minimal expectation modela) Hawthorne Effect fails to improve outlier performance. b) Group sets up minimum thresholds for clinical and non-clinical productivity c) Penalties- either time or money- are accorded to low outliers d) Penalties should be a small part of the total compensation 10/3/2017 Lawrence R. Muroff, M.D., FACR 54

55 Note that financial inequality is clearly not mainstream for radiology practices. 10/3/2017 Lawrence R. Muroff, M.D., FACR 55

56 A Check-List for Action 1) Should we even measure productivity? If a practice is successful, morale is good, and there are no perceived inappropriate productivity differentials, productivity measurements may not be needed (and if implemented, may be destructive to the chemistry of the practice). 10/3/2017 Lawrence R. Muroff, M.D., FACR 56

57 A Check-List for Action 2) If a problematic partner/associate is the genesis of the desire to measure productivity; then deal with the problem, don t implement something to cure an issue that can be dealt with in a more satisfactory manner. 10/3/2017 Lawrence R. Muroff, M.D., FACR 57

58 A Check-List for Action 3) If we decide to measure productivity, what should we measure? a) Choose metrics that are consistent with the goals of the practice. b) This would usually mean that you measure RVU s (pw) and RVU s (nc) c) Decide what non-clinical activities you need for members to value, and how to weight them in your calculations 10/3/2017 Lawrence R. Muroff, M.D., FACR 58

59 A Check-List for Action 4) How should we manage our data? Most practices depend on the Hawthorne Effect, thus, data must be disseminated to the radiologists in a timely, useful, and accurate manner in order to impact behavior 10/3/2017 Lawrence R. Muroff, M.D., FACR 59

60 A Check-List for Action 5) What is the acceptable deviation from the mean? a) Should be determined by the practice b) Should take non-clinical activities into consideration c) Chatter on the listserv. suggested 30%. I think this is too tight a range 10/3/2017 Lawrence R. Muroff, M.D., FACR 60

61 A Check-List for Action 6) Should we reward or punish outliers? a) This is outside the culture of radiology. Therefore it should be a last resort, not a first try for gaining conformity. b) If the practice demands this action, then proceed with caution. Make any penalty or reward relatively small (20% or less of total compensation). 10/3/2017 Lawrence R. Muroff, M.D., FACR 61

62 10/3/2017 Lawrence R. Muroff, M.D., FACR 62