Commentary on wRVU Compensation Models in Academic Centers

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There are currently unprecedented challenges associated with cardiologist compensation. Cardiologists and their organizations – whether private practice, hospital affiliated or academic institutions – uniformly face a rapidly evolving landscape.

Information on the myriad challenges associated with cardiologist compensation have been provided via various resources by the ACC, including articles and perspectives on; Practice Made Perfect podcasts by ACC President C. Michael Valentine, MD, FACC; and ACC's Cardiovascular Summit, the College's annual meeting focused on the business of cardiology.

While there are multiple innovations directed towards a transition from reimbursement (and hence compensation) predicated more on value than volume, most of the collections for an organization are still determined under a fee-for-service model. Hence, many employment models for cardiologists utilize arrangements predicated on work relative value units (wRVUs) as a significant proportion of the overall cardiologist compensation.

There is an evolving recognition by many that wRVU-predicated models of compensation may ultimately be misaligned with the organization's needs, as cardiologists are rewarded for providing services and procedures rather than providing all aspects of patient care, and create disincentives for performing non-wRVU generating activities that would otherwise be beneficial to patients and the organization.

While these issues are of great interest to all cardiologists and organizations, there is even greater concern about wRVU compensation models when utilized in academic institutions. A recent article published by Peter Luong, MS, et al., in the European Heart Journal evaluated the concerns of a wRVU compensation model when utilized in academic centers.

All recognize that academic institutions perform a critical role in American health care. Academic cardiologists are tasked with not only performing clinical patient care (generating wRVUs through a fee-for-service model) but also have many responsibilities in education (both to practicing cardiologists and medical trainees at multiple levels), as well as research.

Luong referrs to evidence that productivity-based compensation formulas have been shown to decrease the willingness of academic staff to perform non-clinical work such as teaching and research. He also references studies that found wRVU employment models in academia have been linked to a decrease in new research publications and in the measure of the quality of the training afforded residents and fellows.

It must be stressed that there is variability between different academic centers and generalizations will not uniformly apply. Yet this compensation misalignment is occurring while academia is facing singular stresses, exacerbated by increasing costs and decreasing cashflows both via funding for research and its training responsibilities, as well as being in an environment of decreasing compensation for patient care activities.

Academic centers need to devise a compensation model that captures and recognizes all actions that are of value to the organization. This is ultimately true for all health care organizations, and physicians should reap the benefits in an increasingly competitive health care environment.

This article was authored by Jesse E. Adams III, MD, FACC, cardiologist at Baptist Health in Louisville, KY.