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I'm building this into our new agreements. It's based on the analytics of the practice - specifically identifying at what point has an employed physician covered all of the expense related to their practice plus an acceptable profit margin to the organization. We've established the maximum $/wRVU rate we are willing to pay, however the physician will not receive that rate until the exceed the minimum number of wRVU. For example - if the minimum wRVU is 5,000 and our max pay/wRVU is $50. We would pay $40/wRVU until the reach 5,001 - at which point they would receive a bonus of $10/wRVU for the 1st 5,000 wRVU and $50/wRVU for every unit going forward. The bonus must be enough to be highly motivating.

Many years back we moved our docs to Work RVU's which is different than the entire RVU as a value for a performed service. The conversion factor is published and changes each year. Go based upon your fiscal year calendar to renew, change, update values to what the Work RVU is. i.e. Jan-Jan, Jun-July. I have not seen anything relating to a sliding scale increasing the conversion factor as productivity increases. The whole point of what the Work RVU is to be reflecting of is to give a value to the amount of time, work, etc, that a CPT code has and the Work RVU is reflective of the physicians time spent, complexity of the procedure, etc. That is why don't use RVU, use Work RVU. Because otherwise, you are giving the doc a much higher value. RVU takes much more into account than physician production. RVU looks at overhead, equipment cost, etc. That is why physicians that are compensated on a productivity model I have always used the Work RVU which you can easily see in getting a Medicode CPT-4 l which contains both RVU value and Work RVU value. If you use RVU you are going to be paying the doc at a greatly higher amount that is not reflective of what the premise of a productivity based compensation model is based upon. Never seen anything on a sliding fee. The whole issue and debate that docs have when they are moved from a salary compensation to a "productivity" compensation is that they 1) Will be all over you so make sure your Work RVU values for each CPT is accurate. 2) Given lag days, you need to have a reporting mechanism for when you produce the Work RVU rept to the docs that you make sure all of your charges are entered into the system for the month. 2) What it really boils down to and why you have gotten this "sliding scale" issue is that Productivity is of course driven by a) number of patients they see, b) Coding for the service at the right level (otherwise they get less Work RVU value), c) I have never seen any leadership agree to some ceiling or bonus if their productivity increases. First, trying to manage and track when the new "higher' conversion kicks in would be difficult. Second, the whole point of why groups have moved docs to Productivity models is because of the fact that when they were salaried, they had no incentive to have a high level of productivity. Work RVU's are the fairest and neutral. Bottom line is, if the doctor wants to increase his salary, then see more patients, seeing more patients, gets more Work RVU's. The days of the docs seeing 20 pts a day are in the past. The driving premise behind this model is the fact that groups were losing per fte doc every month and moving to this compensation model was fair because it was based upon the production of what the physician actually did. If he wants to get a boost, then he needs to get on board and work with your Practice Manager and get his scheduling improved to be able to see more patients in a day