9.18.20
In early August, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for CY 2021, including changes affecting the Medicare Physician Fee Schedule (MPFS). A recent ECG blog post 概述了办公E的拟议工作RVU (WRVU)估值变化&M codes and their subsequent impact on healthcare organizations.
采用基于wrvu的薪酬模式的组织在2021年可能会经历bet8网站备用薪酬支出的显著增加. More concerning, 组织将不会从CMS中获得成比例的收入增长, 由于该机构还提议减少换算系数，以实现预算中立. As a result, 所有目前以基于wrvu的模式向bet8网站备用支付报酬的组织都将经历收入和费用关系的中断. For some specialties, such as medical oncology, this disruption may be significant and, if not addressed, may lead to meaningful financial losses for the organization.
肿瘤学项目应迅速评估这些变化对财务的影响, 因为大多数受雇的bet8网站备用或肿瘤专业的PSA安排都是基于WRVU的. Below, 我们探讨了拟议的WRVU变化对合同bet8网站备用关系的预期影响，并提供了在1月1日变化生效之前减轻财务风险的策略, 2021.
Impact on Oncology Programs
Since medical oncology is predominantly an office-based specialty, 拟议的变化将比放射或外科肿瘤学对其产生更大的影响. 具有CPT编码平均分布的肿瘤医学实践将经历22%的wrvu增加，而放射肿瘤学的wrvu增加了9%. 如果不调整薪酬计划，可能会产生重大的财政影响.
To illustrate the potential impact, 按WRVU计划的中位数美元计算，一名收入中等的肿瘤内科bet8网站备用的报酬可增加约95美元,000 in CY 2021 with no change in practice patterns or productivity. 同样，一名中等收入的放射肿瘤学家可能会增加大约4.6万美元. 表1显示了2020年和2021年wrvu中值与总薪酬的比较.
The impact of these changes at the practice level could be staggering. For example, 一个有10名内科肿瘤学家和5名放射肿瘤学家的肿瘤项目可以得到1美元.2 million increase in compensation expense in CY 2021.
与wrvu和相关bet8网站备用收入的增加有关的两个关键问题.
- Operating Losses: 由于转换系数的重估(大约减少11%), changes in CMS revenue will be less than the new WRVUs. As a result, bet8网站备用补偿(如果基于WRVU)和专业收集之间的差异可能会导致组织的运营损失. Below are two examples for medical and radiation oncologists.
- Assuming median WRVU-based compensation and professional collections, 各组织预计肿瘤医学补偿将增加95美元,000,[1] while professional collections will only go up by $49,000. 因此，各组织在每名肿瘤bet8网站备用身上可能遭受46 000美元的净损失.
- 同样，基于wru的放射肿瘤学家的薪酬预计将增加4.4万美元，[2] and professional collections will decrease by $20,000, resulting in a total net operating loss of $64,000 per radiation oncologist.
- Fair Market Value (FMV): 在生产没有相应变化的情况下，bet8网站备用薪酬的增加可能会推动bet8网站备用薪酬高于合理的市场水平, creating FMV concerns.
Mitigation Strategies
To reduce or eliminate the impact of these changes, 肿瘤项目应该在1月1日前调整现有的基于wru的医师合同, 2021. ECG建议采取两步方法来减轻这些变化的影响.
Step One: Continue Using CY 2020 Compensation Formula
组织可以继续使用他们的2020年CY补偿公式与2020年WRVU时间表和支付转换因子. While holding at the CY 2020 schedule will provide short-term stability, this approach may miss new and/or withdrawn codes, potentially creating a discrepancy between revenue and payments. 值得注意的是，尽管从政治和组织的角度来看，这一步骤可能很容易实施, it can be complicated to implement operationally. 最终，这是一种短期方法，可以在2021年CY进行第二步之前考虑.
Step Two: Adjust the Compensation Structure for 2022 Forward
After a year of experience with the new CPT codes, WRVU values, and associated collections, 肿瘤学项目将更好地准备和计算未来对基于wru的调整compensation rates (e.g.，按WRVU值增加的比例调整每个WRVU的补偿率). Before determining the specific adjustments, ECG建议分析预期的MPFS变化对金融和监管的影响.
考虑到起草和执行修改后的合同通常需要提前60至90天通知, ECG建议各组织在10月份通知bet8网站备用拟议的变更 to be in place by January 1, 2021. 表2中的时间表将使组织能够在年初之前对2021年CY合同进行必要的更改.
Because an oncology program’s 具体的战术可能有复杂的补偿公式，重要的是要 执行财务建模，以准确了解您的肿瘤学计划如何 be affected over the long term.
Timely action will allow your 组织主动管理这些变化对财务的影响 preserve compliance with FMV standards. ECG is available to support your 组织评估2021年强积金计划变化的影响 评估与bet8网站备用安排相关的脆弱性，分析 financial and regulatory implications, and identifying the appropriate mitigation tactics to reduce financial exposure. Please contact us at [email protected] for more information about our services.
Footnotes
- 1.
假设肿瘤医学赔偿是基于WRVU产量中位数乘以WRVU费率中位数赔偿(等于431美元),801) and median professional collections ($347,894)是基于MGMA 2020年国家综合基准的同等权重混合, AGMA, SullivanCotter, and ECG.
- 2.
假设放射肿瘤学的赔偿是基于WRVU产量中位数乘以WRVU费率中位数赔偿(等于515美元),725) and median professional collections ($660,691)是基于MGMA的2020年国家综合基准的等权重混合, AGMA, SullivanCotter, and ECG.