Background:
Many hospital medicine groups have hospitalists with individualized job descriptions who work variable types and numbers of shifts. This creates challenges in crafting a universally applicable productivity metric, as different shifts target different types and volumes of work. An effective yet equitable system that accounts for differences in work schedules is needed.
Purpose:
Our objective was to create a productivity incentive to fiscally recognize hospitalists based on their individualized work schedules. We explored the impact of the incentive on work relative value unit (wRVU) generation and examined billing patterns to monitor for inappropriate “upcoding.”
Description:
At our institution, hospitalists work a variable number of daytime, evening and night shifts at two different locations. Each site and each shift has its own unique number and pattern of billable encounters. Baseline data were collected from October 2012 to March 2013 to determine the mean wRVUs generated in each shift at each site. In addition, we obtained baseline census data and the number of evaluation and management (E/M) charges submitted. Expected wRVUs for each shift were set by consensus. Individualized wRVU targets were determined for each hospitalist based on the number of each type of shift worked. The available incentive pool was split among all hospitalists achieving productivity thresholds with the individual incentive amount based on each physician’s percentage above threshold achieved, adjusted for percentage of full‐time equivalent.
Although our intervention occurred during a time of significant census growth (22.5% increase compared to pre‐implementation), we observed a disproportionate increase in the number of charges submitted (40.0%) and wRVUs (41.3%) (Table 1). The number of hospitalists who met productivity targets increased with the intervention, and we observed no significant change in the percentage of level‐3 E/M charges (Table 2).
Conclusions:
The creation of an individualized productivity incentive based on the expected wRVUs for the type and number of shifts worked is an equitable and effective way to distribute incentive funds. Despite a relatively modest payout [mean incentive $1357 (range $334‐$2446)], 87% of hospitalists exceeded incentive targets.
In addition, there was a significant rise in wRVUs not accounted for by census growth. This likely reflects the impact of the incentive on physician charge capture, as the number of charges submitted exceeded the corresponding increase in census. There was no evidence of “upcoding” based on stability in the rates of level‐3 E/M charges.
