Productivity is one of those esoteric concepts that every business embraces but few can define.
Mark Murray, M.D., a healthcare consultant in Sacramento, Calif., tries to grasp it: "Is productivity based on encounters? Panel size? RVUs? Robustness of visits (in terms of patient satisfaction and clinical outcomes)? Or is it a combination?"
The answer often depends on the payer mix.
"In a pure capitated environment, productivity should be based on panel size--how many patients do you have?" he says. "It becomes necessary for me to manage their chronic conditions better" to avoid repeat visits that won't generate additional revenue.
"In a fee-for-service environment, where revenue floats, panel size can float."
The goal is to see more patients with high relative value units. "You want to maximize revenue per visit," Murray says.
In general, medical groups see capitation as a barrier to enhanced productivity.
The Everett (Wash.) Clinic, a large multispecialty group in the Seattle suburbs, terminated the last of its capitated managed care contracts at the end of 2000.
An incentive plan encourages the group's physicians to deliver quality care, but they no longer feel pressured to control utilization, says medical director Al Fisk, M.D.
This approach does not mean reducing the number of visits to the point that patients have to wait weeks for appointments, however. "There's no escape valve on the waiting side," Murray cautions. "If (a physician) takes more patients, her revenue isn't going to go up. The fixed points are patient satisfaction and clinical outcomes."
To Rick Weymier, director of physician services at VHA, a national network of independent healthcare organizations: "An increase in productivity doesn't lead to greater revenues or income if productivity is based solely on patient volume.
There's a lower dollar reimbursement per patient, but hours are increasing. Instead of 28 hours a week of patient contact, they're now doing 33 to 36."
The workload might be even higher if more than 25% of a physician's patients are on Medicare, Weymier says.
However, if a fee-for-service organization pays physicians purely on salary and the practice doesn't pay close attention to costs, "nothing (positive) happens" on the cost side of the income statement, according to Murray. "You need enough patients to be able to pay your rent."
"Success is more than (having) enough revenue," Murray says. "Some groups compensate the doctors all the same but pool the revenue and divide it."
Weymier believes that medical groups should bring managed care into the productivity equation as well. "Set collaborative goals with all payers," he says. "Look for things that are important to both parties and focus on two or three things to improve rather than trying to fix everything across the board."