Why RVU is Not a Great Way to Track Production for Surgery PAs and Alternatives to Track Production
One way to be compensated for your work as a PA is to be paid based on production (how much money you bring into the practice). This is commonly done by tracking workRVU’s. If all the work you do is billed under your name, than this can be a great way to be compensated. However, if you work in a surgery sub-specialty and do a lot of work that is not billed under you, than it is not all reflected in a workRVU report. This is not the best way to keep track of what you have done and your compensation probably should not be based off this style of production pay.
If you work in a specialty like orthopedics, urology or general surgery a lot of the visits you see might be pre-op and post-op patients. These visits are typically covered under a global fee for the surgery. The surgery is billed out under the name of the surgeon, but the PA might be doing some of the work under the global period before or after a surgery.
You might also be first assisting on surgeries. Some surgeries allow for a first-assist fee to be billed, but not all surgeries allow for a first assist. Does this mean if a first assist is not billable we shouldn’t use PAs as first assist? Not necessarily, a first assist can make a surgery easier on the surgeon which provides value to the surgeon. Even though it might help make the surgeon’s life easier most administrators don’t really care about that.
From a profit standpoint using a first assist can possibly increase production of the surgeon. Instead of using one room a MD/PA team could possibly use two rooms. The PA can prep one room while the surgeon finishes in the other room; or the PA can be closing in one room while the surgeon is doing post-op notes and orders. By using a PA this can increase the number of surgeries done in a day, which means more money coming into the practice.
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As we can see there is a lot of work that is happening that is not necessarily reflected in workRVUs. The difficult part is coming up with a way to track the work that is happening. One possible solution is to track production of an MD/PA team. By doing this you can look at the workRVUs that the surgeon and PA are doing together. Once you have a combined report the PA would be given a percentage of the total.
If there is a concern that a combined workRVU report does not properly reflect total production, another way to look at it would be total collections. Similar to the combined workRVU report you would want to look at the total amount of payments the MD/PA team is bringing in, and base compensation off this number in the form of a bonus or increase in base pay.
I was previously given a job offer in urology, and they had suggested a similar approach to determining the bonus based off production. However, they did not want to put it in writing before signing a contract, so I ended up declining the offer.
The combined report can work well if the teams are set up with one MD and one PA. The same concept can be used for larger teams, but the work that everyone is doing becomes a little more convoluted. If you work in a practice where PAs work with different physicians on a daily basis or where some PAs first assist and others only see patients in office visits, it might be harder to determine who is doing the most “work”. For production based bonus to work for a larger team it is important that everyone has a team mentality, and using a regular rotation for duties can help with this.
Production based pay is a great way to be compensated for the work that you do, but the work that is being done is not always clearly recognized with production reports such as those based on workRVUs. There are still ways to figure out a production based bonus, but it might need a more creative approach with how production is tracked for a PA. If you feel that production pay is important make sure you discuss this with a potential employer prior to accepting a position, and have it clearly written out prior to accepting a job.
Have you had to create a system for production bonus for PAs in a surgical specialty? What do you think is a good way to be compensated for PAs in surgery? Please comment below the original post, sign up to receive future posts by email and share with your friends!
