Physician Pay Shifts from Volume to Value

The implementation of an RVU system incorporating quality measures would be aided by documentation templates in the electronic medical record, similar to templates emerging for care bundles like central line bloodstream infection. Value-based RVUs would have challenges, such as the need to change the measures over time and the system gaming inherent in any incentive design. Details of implementing the program would need to be worked out, such as attributing measures to individual physicians/providers or limiting to one the number of times certain measures are fulfilled per hospitalization.

Once established, a value-based RVU system could replace the complex and variable physician compensation landscape that exists today. As has always been the case, an RVU system could form the basis of a production incentive. Such a system could be implemented on existing billing software systems, would not require additional resources to administer, and is likely to find acceptance among physicians, because it is something most are already accustomed to.

Current efforts to pay physicians based on value are facing substantial headwinds. The Value-Based Payment Modifier has been criticized for being too complex, while the Physician Quality Reporting System, in place since 2007, has been plagued by a “dismal” adoption rate by physicians and has been noted to “reflect a vanishingly small part of professional activities in most clinical specialties.” (N Engl J Med. 2013;369:2079-2078). The time may be right to rethink physician value-based payment and integrate it into the existing, time-honored RVU payment system.

Dr. Whitcomb is chief medical officer of Remedy Partners in Darien, Conn. He is co-founder and past president of the Society of Hospital Medicine.

This article first appeared in The Hospitalist, and has been adapted with permission from the Society of Hospital Medicine.