Physician Compensation Data – Questions and Answers for the Era of Value-Based Payments

Part II: A Conversation with Representatives of Medical Group Management Association (MGMA)

This webinar is sponsored by the following AHLA Practice Groups: Fair Market Value Affinity Group, Hospitals and Health Systems Practice Group, Physician Organizations Practice Group, In-House Counsel Practice Group, Academic Medical Centers Practice Group, and Tax and Finance Practice Group

Panelists

Moderator: Kathryn Hickner Vice-Chair, Physician Organizations Practice Group khickner@ulmer.com

Rachel Weber Data Analyst Medical Group Management Association (MGMA) rweber@MGMA.org

Timothy Smith Ankura Consulting Group, LLC Tim.Smith@Ankuraconuslting.com

FMV Affinity Group Leadership

Chair, FMV Affinity Group Andrea M Ferrari HealthCare Appraisers, Inc. Delray Beach, FL

Vice Chairs, FMV Affinity Group: Curtis H. Bernstein Pinnnacle Consulting Denver, CO Alaina Crislip, Esq. Thomas Health System South Charleston, WV Shane Goss Huron Consulting Chicago, IL Lyle Oelrich Pershing Yoakley & Associates PC Knoxville, TN Joseph N. Wolfe Hall, Render, Killian, Heath & Lyman, P.C. Milwaukee, WI

About the Webinar Series

• This 3-part webinar series will consist of discussions with representatives of organizations that perform and publish well-known physician compensation surveys. They will provide information regarding: Their current survey questions and surveyed populations;

Data reported/collected in the most recent publication(s) of their surveys, and how to find it;

Trends, if any, in recent survey data, including trends with respect primary care physicians and trends with respect to payments based on measures other than productivity; and

Forwarding-looking predictions regarding future surveys and changes.

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About the Webinar Series

Session #1 – August 15, 2016: A Discussion Regarding Academic Physician Compensation Focus: AAMC and MGMA Academic Surveys

Session #2 – August 22, 2016: A Conversation with Representatives of Medical Group Management Association (MGMA) Focus: MGMA Physician Compensation and Production Survey and

related MGMA resources and tools

Session #3 – August 29, 2016: A Conversation with Representatives

of American Medical Group Association (AMGA) Focus: AMGA Medical Group Compensation and Financial Survey and

related AMGA resources and tools

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About the Webinar Series Why we think this series is important/useful for listeners:

Physician compensation, particularly for employed physicians, is a “hot button” issue

More often than not, ensuring that compensation is fair market value (“FMV”) and “commercial reasonable” is a lynchpin for a regulatory-compliant transaction or arrangement

Stark Law (strict liability)

Anti-Kickback Statute (safe harbors)

IRC §501(C)(3) (no private inurement)

State laws aka “mini-Stark” (anti-self referral) laws, state and local tax-exemption requirements, state licensing rules, etc.

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About the Webinar Series Why we think this series is important/useful for listeners:

But … the question of how to appropriately evaluate and document FMV and commercial reasonableness seems increasingly difficult to answer

As the market shifts from fee-for-service to value-based reimbursement, and the “rules” of reimbursement change, there are many new questions about proper forms and amounts of compensation

Survey data are an important and powerful tool for helping to answer “hot button” questions about FMV and commercial reasonableness, but …

“Survey data are only as good as the understanding of the person reviewing the data.”

Survey data have limitations and nuances

The webinar series has been designed to provide insight into physician compensation in the changing reimbursement environment, with specific focus on the new data and resources that are available to assist health care counsel and clients to understand the factors affecting FMV and commercial reasonableness in the evolving marketplace.

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General Program Agenda Part I: An overview of the MGMA Physician Compensation and Production Survey:

The population surveyed and reflected in the survey data

The questions asked in the survey

The data reported/collected in the most recent publication of the survey results, and how to find and use such data

Part II: Discussion of trends in and uses of specific types survey data, and what you need to know to understand them. We will focus on:

How to translate Part I to an understanding of what specific survey data can and cannot tell you

How MGMA expects or intends for its survey data to be used

How survey data may or may not reflect trends in a changing marketplace

How, as the care environment and reimbursement landscape transitions from fee-for-service to care management & population health, survey processes, survey data and/or data uses might be expected to change, and what this means for lawyers and compliance officers

Part III: Audience questions and answers

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Discussion – Part I An Overview of the MGMA Physician Compensation and

Production Survey and Related Surveys:

Population

Questions

Data reported

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MGMA Surveys

• Compensation Survey

• January through March

• Physicians, managers, faculty

• Additional Data Sets

• Academic, Medical Directorship, On-Call, Starting Salary

• Cost and Revenue Survey

• February through April

• Medical group practices

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MGMA Surveys

• Survey Population and Metrics

• Provider Compensation DataDive

• Medical practices, hospitals, IDSs

• Total compensation – W2

• Retirement benefits

• Productivity

• Does not include quality

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MGMA Surveys

• Survey Population and Metrics

• Compensation and Production

• Academic Compensation

• Medical Directorship Compensation

• On-Call Compensation

• Physician Placement Starting Salary

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MGMA Surveys

• Survey Population and Metrics

• Cost and Revenue DataDive

• Medical practices, hospitals and IDSs

• Operating Cost

• Total Medical Revenue

• Staffing Ratios

• Per FTE Physician, square foot, work RVU

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MGMA Surveys

• Survey Population and Metrics • Participant demographics

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MGMA Surveys

• Survey Methods

• Invitation via blast email, web, social media

• Electronic data capture

• ORCA

• Data editing

• Logic, outliers

• Required questions

• Eligibility

• Free results

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MGMA Surveys

• Survey Methods

• History

• 1926

• Industry expert review

• Future

• Data Automation

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MGMA Surveys

• Reporting Methods

• Mean vs. median

• Sample size

• Calculating data across tables

• Example, compensation to work RVU ratio

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MGMA Surveys

• Compensation Survey Results

• Volume and variety of participation

• Categorized by practice and provider demographics

• 2015 data released in May of 2016

• Previous year trending

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MGMA Surveys Examples of filter options: Group specific • Geographic region, minor region

and state • Practice ownership • Total medical revenue • Number of FTE physicians • Practice type

Examples of filter options Provider specific • Years in specialty • Weeks worked per year • Providers had on-call duties

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MGMA Surveys

• DataDive

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MGMA Surveys

• DataDive Pro

• Additional report layouts

• Additional benchmarks

• Additional filter options

• Additional percentiles

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Discussion – Part II Part II: Discussion of trends in and uses of specific types survey

data, and what you need to know to understand them. We will focus on:

How to translate Part I to an understanding of what specific survey data can and cannot tell you

How MGMA expects or intends for its survey data to be used

How survey data may or may not reflect trends in a changing marketplace

How, as the care environment and reimbursement landscape transitions from fee-for-service to care management & population health, survey processes, survey data and/or data uses might be expected to change, and what this means for lawyers and compliance officers

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Current & Future Compensation Trends

• Compensation to work RVU Relationship

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Current & Future Compensation Trends

• Pay to Production

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Current & Future Compensation Trends

• Total Compensation Trends • Primary and specialty care – median compensation

$-

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

$300,000.00

$350,000.00

$400,000.00

$450,000.00

2011 2012 2013 2014 2015

Five Year Compensation

Primary Care Specialists

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Future Surveys

• MGMA Stat • Timely questions and results • Weekly text poll • 50% response rate

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Future Surveys

• Practice Operations • New MGMA survey

• July through August

• Metrics

• Call volume and handling time

• Charge-posting lag time

• Claims processed per day

• Patient access and wait times

• Free results to participants

• Available to purchase

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Wrap Up Summary & Questions Survey data reflect aggregate cash compensation to the

extent aggregate cash compensation is reported What is the extent to which some forms of physician compensation

may go unreported or not clearly reported – e.g. – quality bonuses that are not productivity-based, meeting pay, administrative services pay, etc.?

What is the impact of call coverage on compensation? To what extent is it reflected in aggregate cash compensation values reported by MGMA?

What is the impact of administrative compensation? How and to what effect does it impact compensation per RVU rates?

In the context of compensation stacking, how can we know or determine the impact that wRVU productivity has on compensation?

In starting salary surveys, do the guaranteed compensation amounts include or exclude loan forgiveness and sign-on bonuses?

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Wrap Up Summary & Questions

Aggregate cash compensation values do not include the cash value of fringe benefits Do fringe benefits vary in the marketplace? How might this factor

into compensation planning for a party that is concerned about ensuring FMV and commercially reasonable compensation but is contemplating a rich benefits package? Are there survey benchmarks to assist with evaluation of the reasonableness of benefits?

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Wrap Up Summary & Questions

By nature, survey data (although highly useful) are imperfect. Survey data may not perfectly represent all physicians. With respect to the MGMA surveys: What kind of judgments can we make about the US marketplace

based on the MGMA data? For example: Does the mix of physicians from hospital-owned practices vs.

physician owned practices indicate the current level of hospital employment of physicians in the US market?

Is a physician who receives compensation above the 90th percentile one of the highest paid physicians in America?

Is a physician who receives compensation consistent with the 25th percentile underpaid?

Is the median compensation representative of what most doctors make? How do we interpret medians or other percentiles?

How do we interpret $/wRVU values at percentiles greater than the median?

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Wrap Up Summary & Questions

By nature, survey data (although highly useful) are imperfect. Survey data may not perfectly represent all physicians. With respect to the MGMA surveys:

Do the reported data represent descriptive or inferential statistics?

MGMA data are reported on a regional basis. What are the regions? Are data from all states/geographical areas included in those regions?

What do linear regression and R2 values tell us about compensation values reported in the MGMA surveys?

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Wrap Up Summary & Questions

Survey data are necessarily retrospective If payment rules/trends changed in 2015/2016, the effect would not

be evident until the 2017 or later publications of a survey?

Does this suggest the need for caution and/or critical analysis when using survey data for prospective compensation planning in a changing marketplace?

What tips can you give for using survey data for prospective compensation planning? Are there: Pitfalls to avoid?

Tools to use?

Reasonable assumptions based on trends?

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Additional Questions?

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American Bar Association.

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