Since 2023, physician productivity as measured by work relative value units has increased 12%, and APP productivity has increased 11%, according to Kaufman, Hall & Associates.
With a nationwide shortage of physicians in many specialties, it is important for health systems, hospitals, and medical groups to achieve high productivity from the clinicians they have on staff. Lower levels of productivity can be a major barrier to growth.
Physician and advanced practice provider (APP) productivity has increased significantly over the past two years, according a recent Physician Flash Report from Kaufman, Hall & Associates.
The Physician Flash Report has three key takeaways.
- Since 2023, physician productivity as measured by work relative value units (wRVUs) has increased 12%. APP productivity has increased 11%.
- Net patient revenue per provider overall has also increased, although there was a slight decrease in surgical and hospital-based revenue that is likely related to an increase in outpatient care.
- Medical support staff levels have decreased, which likely stems from difficulties with hiring and retention of medical support staff such as medical assistants.
Daniel McGovern, MBA, is vice president of finance for Virtua Medical Group. Photo courtesy of Virtua Health.
How the trends have played out at a large medical group
Over the past two years, physician and APP productivity have increased at Virtua Medical Group. Since 2023, the medical group has posted a 16% increase in physician productivity and a 17% increase in APP productivity, according to Daniel McGovern, MBA, the medical group's vice president of finance.
Clinician retention has been a primary driver of productivity gains at the medical group. If there is a lot of turnover and onboarding of new physicians and APPs, McGovern explains, the productivity on average will be lower for a medical group.
"With turnover, there is a ramp-up period, where physicians and APPs are learning about the health system, the electronic medical record, and building up patient panels," McGovern says. "Overall, we have been very fortunate with retention, with a 96% retention rate for our provider workforce."
Several initiatives at the medical group have contributed to the increase in physician and APP productivity, according to Samuel Weiner, MD, vice president and CMO of Virtua Medical Group.
"We have done things that are not necessarily directed at increasing productivity but have had a side effect of increasing productivity," Weiner says. "This includes making our electronic medical record easier to use. We have made the interface easier to use, so our clinicians can get through clinic visits quicker and with more direct contact with the patients."
Efforts to make the medical group's electronic medical record easier to use have included integrating artificial intelligence into the EMR. For example, AI is helping to answer questions that are sent to clinicians through the medical group's patient portal.
"The AI can generate a response back to the patient to get the conversation started," Weiner says. "The clinician still needs to send the answer back, but the AI goes a long way to answering clinical questions, with the clinician tailoring the response."
The medical group also is using an ambient listening tool to record the interactions between clinicians and patients, then generate a clinical note of the encounter to ease the documentation burden for clinicians.
"The ambient listening tool not only makes clinicians more efficient but also gives them the opportunity to squeeze a patient in for an appointment at the end of the day if a patient needs an appointment at the last minute," Weiner says.
Since 2023, Virtua Medical Group has experienced about a 1% decrease in net revenue per wRVU for its surgical specialty and musculoskeletal specialty.
"Our inpatient surgical volume has not decreased. It has actually increased, especially in terms of our transplant physicians and cardiovascular physicians," McGovern says. "However, with our growth, we have had a lot more outpatient volume in general at Virtua Medical Group, which has shifted the percentage of net revenue to the outpatient side."
In 2023, Virtua Medical Group had about 38% of service volume coming from inpatient services. This year, about 34% of service volume is coming from inpatient services.
"We have been performing more office procedures, particularly with the acquisition two years ago of a large musculoskeletal group," McGovern says. "They do more than 5,000 office procedures per year, which has shifted some of our portfolio to the outpatient side."
The medical group has also experienced a rise in procedures conducted in ambulatory surgical centers, according to McGovern.
Virtua Medical Group has bucked the trend of lower medical support staff levels.
"We have been able to increase our medical support staff levels in recent years," McGovern says. "We have found that productivity will drop in clinician offices if they do not have enough support staff. We have increased the number of support staff by 11% over the past two years at the request of the practices."
Maintaining competitive medical support staff compensation has been crucial, McGovern explains.
"We are fortunate to have support from our corporate compensation department, which has been doing regular market reviews of support staff salaries," McGovern says. "We make adjustments if salaries fall below the market rates. That has helped to ensure that we are paying market value for our medical support staff positions."
Samuel Weiner, MD, is vice president and CMO of Virtua Medical Group. Photo courtesy of Virtua Health.
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
Net patient revenue per provider overall has also increased, although there was a slight decrease in surgical and hospital-based revenue that is likely related to an increase in outpatient care.
Medical support staff levels have decreased, which likely reflects difficulties with hiring and retention of medical support staff such as medical assistants.