In my last post, I laid out three unspoken assumptions that practices make when they put their faith in WRVU-based physician compensation models to fix access or financial issues. Understanding each of these assumptions and making the appropriate adjustments will help you ensure that your physicians (and your practice) are in the best position to succeed.
Let’s talk about the first of these assumptions, that physicians should be able to match benchmark WRVU levels without too much effort.
In a typical WRVU-based compensation model, physicians get a bonus for each WRVU above a certain threshold. Put another way, the model incentivizes them to meet (and exceed) a WRVU goal.
But how do you decide where to set that goal?
If you’re like many of the hundreds of practice leaders I’ve worked with, you’ll probably select a benchmark from MGMA or one of the other publicly available physician compensation surveys. The national median annual WRVUs per FTE physician for their specialty, perhaps.
Now, let’s consider whether this goal is a SMART goal:
- [S]pecific – Goals should be clear and well-defined, so there is no doubt what you’re working toward.
- [M]easurable – In addition to having a concrete objective in mind, measurable goals require that there is a relevant metric linked to the outcome.
- [A]chievable – To increase the chances of a goal being achieved within your desired timeframe, it should be realistically achievable.
- [R]elevant – Relevant goals should align with the values of the practice as a whole.
- [T]imebound – There must be a deadline for achieving a goal.
As you can see, you almost have a SMART goal, but it could fall short in one very important way, because the national median WRVU benchmark may not be achievable for your physicians in your practice. When this happens, your physicians get frustrated because the bar feels too high and you get frustrated because you aren’t seeing enough progress.
Why does this happen? As I’ve written before, benchmarks represent averages of many different practices in many different communities across the country. They don’t necessarily reflect your practice’s patient population, payer mix, support staff, physical space, etc. Because all of these things (and many, many other factors) shape what’s actually possible for your physicians, you may inadvertently be setting them up to fail.
So, how can you set your physicians up for success?
In the short term, you can create your own achievable WRVU goals based on what your physicians have been able to do within your practice. Start by breaking down historical WRVU data into clinical hours worked and WRVUs per clinical hour. Note trends in the data and think about what factors might explain peaks and valleys. Once you have an achievable WRVU per clinical hour target, you can apply it to the number of clinical hours your physicians are working to get a goal that should work for them. (A good rule of thumb is that a physician should have a 50% likelihood of meeting the goal you’ve set for them.)
Over a longer time period, as you see physicians getting motivated by a sense of achievement and the support they’re getting from management, you can start to raise the bar. Revisit the benchmark data and consider how your practice might be different than the “typical practice” that’s included. Think about how you could invest in additional staff or space, reconsider the expectations your practice has for your physicians, and/or develop initiatives to make the most of your practice’s precious resources. After all, you’re talking about doing something that you haven’t done before.
This work isn’t about lowering the bar; it’s about building the conditions that allow physicians to actually reach it. When goals match reality, productivity improves naturally, burnout drops, and you create a foundation strong enough to grow on.
In my next post, I’ll be tackling the assumption that physicians can choose to be more or less productive.
