Panel Session: Measuring Academic Productivity in VA

The 2019 Annual Meeting of the AVAS was blessed with several enlightening panel discussions.

The final session (moderated by David Berger, MD and Jason Johanning, MD) was a lesson on “MEASURING ACADEMIC PRODUCTIVITY IN VA”. Eileen Moran, MS (Director, VHA Office of Productivity, Efficiency, and Staffing, ​West Haven, CT) initiated the conversation by providing helpful hints on “MEASURING VA SURGEON PRODUCTIVITY NOW AND IN THE FUTURE “. Dr. Moran reviewed data that most of us were not aware of. The office of productivity is capable of compiling data across the entire VA workforce. Across the board, VA surgeons work an average of 80% clinical FTE. OR case numbers have only risen 20,000 over the past five years. Unique patient workload in surgery has been consistently steady at 1.5M for the past five years and unique encounters in surgery have risen 500K over the past five years. Dr. Moran, discussed that among the reasons for instituting a productivity model in the first place, one reason was to provide incentives for work, identify barriers to efficient care, identify providers who require assistance, and to distribute work equitably. In theory, by creating a standardized measure, all practices would be on equal ground for that specialty. Surprisingly, for five years over 50% of surgeon RVU’s have been generated in the non-procedural setting. In addition, most of us were surprised to learn that the surgeon workforce has been very stable for the past five years, with the only significant change being that contract and fee provider numbers have steadily declined with a proportionate rise in employed staff. Specialties that have seen the most significant decline in the past five years include neurosurgery, thoracic surgery and general surgery. Gynecology has seen the highest increase. Ophthalmology has generated the highest productivity scores. Dr. Moran concluded by explaining the useful aspects of the SPARQ tool. Brian R. Smith, MD (VISN 22 Chief Surgical Consultant) followed with his query on “IS STANDARIZED MEASUREMENT OF SURGEON PRODUCTIVITY ACROSS ALL VA'S THE RIGHT APPRAOCH? “. Dr. Smith compared the VA productivity measuring system with that of other institutions. The VA uses work RVU’s and Clinical FTE. Work RVU’s (wRVU) are created thru the summation of RVU’s collected during a provider’s work hours. An entire specialty’s RVU’s are then added to determine the total RVU for that specialty. Clinical FTE are calculated from the labor mapping calculation whereby non-clinical hours are subtracted out. Total Clinical FTE are determined by the sum of the entire Specialty’s Clinical FTE. For the individual and the specialty productivity scores are then created by dividing the wRVU by the clinical FTE. An individual and that specialty can then be compared to the mean productivity score for that specialty in the same facility complexity level. This process relies entirely on that individual being classified in the right specialty (taxonomy) and in the correct mapping of their pay-period workload. Other productivity models rely on clinic wait times, OR wait times, or RVU’s generated per hour or patients seen per hour. Other rely on charges or dollars collected per hour. In the end there was agreement that the system requires a model that incentivizes providers but remains patient centered, easily measurable, and not easily corrupted. Carolyn M Clancy, MD (Deputy Undersecretary for Health, Discovery, Education and Affiliated Networks Department of Veterans Affairs, Washington, DC) pondered the burning question, “CAN VA MAINTAIN ITS TRADITIONAL ACADEMIC MODEL IN THIS DAY AND AGE? “. Dr. Clancy provided an honest opinion on the direction the VA was likely leading in terms of productivity. She acknowledged that the VA compensation model does not coincide with our academic affiliate goal as it does not account for actual academic productivity (teaching and research). The VA provides an opportunity for young physicians to become researchers. Many simply would not have had that opportunity outside the VA. Dr. Clancy concluded her discussion by reminding us that “we have one foundational service and that is to provide integrated care to our patients” and that “we have a strong foundation”. However, “we do have a lot of opportunity to provide improved care for our veterans”. Mark Wilson, MD PhD ​(Professor and Chief of Surgery, VA ​Pittsburgh Healthcare System ​Acting Director of Surgery, National Surgery Office) concluded with his thoughts on “PRODUCTIVITY AND PERFORMANCE “. Mark Wilson began his discussion by explaining that physicians have mistakenly accepted that productivity (wRVU) is a definitive measure of performance. Productivity measures need to account for time (input) and workload measure generated (output). Accurate measures should include all input and output measures but for physicians that does not appear to be the case. A more accurate system would not only include time as an input but also support staff and other resources. A fair model would also include the work done doing research and educational activities. The problems identified with most productivity models are that they are assumed to lead to improved performance and identify low performers but they can actually impair production. In the end there must be a balance between motivation, efficiency, customer satisfaction, quality and productivity. The reality is that clinical volume will always be a factor in measuring productivity.

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