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MD Ranger’s 14th year of reporting features thousands of benchmarks derived from a database of more than 50,000 contracts from over 225 hospitals and hundreds of health care providers across the US, making it the largest survey of non-salaried physician payments. Benchmarks include ED Coverage, Medical Directorships, Administrative Services, Hospital-Based Services, Medical Staff Leadership, Telemedicine, Diagnostic Testing, and Clinical Hourly Rates. Salary and productivity benchmarks are also available and will be updated in the coming months. This year, MD Ranger reports 17 new physician services, including per delivery payments, neuro-hospitalists, and trauma critical care payments.

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While payment rates in the MD Ranger database are very stable, the company observed large increases in both hospital-based arrangements and ED call contracts in 2022. Market forces such as post-pandemic labor shortages, reduced Medicare payments, and increased patient load likely contributed to much larger than expected increases in many payment rates. Penny Stroud, Founder and CEO of MD Ranger states “The COVID-19 pandemic exacerbated the challenges associated with physician contracting. An aging workforce, increasing specialization, and the growing divide between inpatient and outpatient physician practice continue to drive payment rates up. Benchmarks have increased the most in ED call payments and hospital-based group arrangements, with specialties like ENT, Oral/Maxillofacial, and Pediatric Surgery increasing significantly. Payment for gastroenterology services continued to rise, with a 13% rise in median call pay and 34% increases in ERCP and other GI procedures. Trauma Surgery, Anesthesia, and General Hospitalist services command the highest annual median payments for hospital-based services, each costing more than $1.5M in total payments”.

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Key findings from the 2023 benchmarks include:

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· ED call payments experienced the largest increases in several years. Of the 54 call services, only 24% declined at the median while 67% increased, including 30% of services increasing more than 10%. However, for the services that declined at the median, most increased at the 75th percentile, indicating increasing spread between the median and 75th percentile. Services with more than 20% increases include ENT, Pediatric Surgery, and Obstetrics. According to the MD Ranger database, the average hospital spends just over $4M per year on ED coverage payments alone with the average hospital having 12 paid positions.

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· Since 2018, payments for Critical Care/ICU have more than doubled, from a median per diem coverage rate of $1,880 to $4,050 in 2023. With recent changes in the Medicare Fee Schedule and an aging population, MD Ranger anticipates continuing pressure on these arrangements.

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· MD Ranger observed increases in annual payments for administrators and committee members such as Credentials Committee, Practitioner Health and Wellness Committee, Peer Review, and Patient Safety Officer. Payments for Credentials Committee have nearly doubled since 2021. While more annual payments increased than decreased, annual payments overall remain relatively stable from last year to this year. Since the late 2010’s, MD Ranger has observed slight decreases in annual hours across services although there are exceptions.

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Health care providers use MD Ranger to set payment rates, document fair market value, and comply with federal Stark and anti-kickback regulations. MD Ranger is used by hundreds of healthcare organizations, including hospitals, health systems, trauma centers, medical groups, LTACs, outpatient providers, and critical access facilities.

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About MD Ranger

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MD Ranger partners with leading health care provider organizations to provide comprehensive market data, simplify the FMV process and document physician transactions efficiently and cost-effectively.

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The post MD Ranger’s 2023 Report: New Benchmarks Suggest Upward Pressure on Hospital Physician Contracts appeared first on MD Ranger.

MD Ranger’s 13th year of reporting features 1500+thousandsof benchmarks derived from a database of over more than 45,000 contracts from hundreds of over 225 hospitals and health care providers across the US, making it the largest and most comprehensive survey of non-salaried physician payments. Benchmarks include ED coverage, medical directorships, administrative services, hospital-based services, medical staff leadership, telemedicine, diagnostic testing, and clinical hourly rates. Salary and productivity benchmarks are also available and will be updated in the coming months.

Health care providers use MD Ranger’s benchmarks to set payment rates, document fair market value, and comply with federal Stark and anti-kickback regulations. MD Ranger is used by hundreds of healthcare organizations, including hospitals, health systems, trauma centers, medical groups, LTACs, outpatient providers, and critical access facilities.

The COVID pandemic impacted Infectious Disease payments, with median call coverage rates rising25% from a pre-COVID 2019 rate of $240 to 2022at $300 in 2021. Likewise, Infectious Disease administrative payments increase 20% at the median and 43% at P75, to $60,400annually. The rise in Hospitalist and Intensivist payments may also be the result of in higher COVID-related costs. Clinical hourly rates for Intensivists rose 28% at P75 to$250 per hour.

Key findings from the 2022 benchmarks include:

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• ED call coverage remains a significant expenditure with the average hospital spending nearly $4m for a year for coverage with twelve paid specialty panels. Trauma centers spend considerably more – on average $7.7 million annually. Payment differentials can be large for some specialties: Orthopedic Surgery ED call rates at trauma centers are $2,680 at P75 and $1,200 at non-trauma centers at P75.
• Despite increasing costs for ED call coverage, telemedicine is changing emergency call coverage panels for select specialties. With the increasing cost of ED coverage for stroke care and a limited supply of neurologists willing to take call, some hospitals have substituted or augmented neurology panels with telestroke providers. Median payments for neurology have stabilized at around $600 per diem while 75^th percentile payments continue to rise, with a 12% increase to $870 from 2021 to 2022.
• Critical Care/Intensivist arrangements continue to grow in scope. According to MD Ranger’s 2022 benchmarks, The median annual stipend payment for Critical Care is $988,600. Five years ago in 2017, the median was $603,300, a 64% increase.
• While the number of medical direction positions at hospitals have increased over the years, physicians are generally spending less time in these administrative roles. Since 2017, MD Ranger has observed decreases in annual hours across services although there are notable exceptions. Non-director administrative roles such as Care/Case Management, Utilization Management, and Quality Initiatives have all increased in annual hours. Care/Case Management had the largest increase at 80% over a five-year period from 530 hours to 960 at P75.

The post MD Ranger’s 2022 Report: New Benchmarks Suggest the Growing Scope and Complexity of Physician Transactions at Hospitals and Health Systems appeared first on MD Ranger.

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MD Ranger’s 12th year of reporting features thousands of benchmarks derived from a database of more than 42,000 contracts from over 300 hospitals and hundreds of health care providers across the US, making it the largest survey of non-salaried physician payments. Benchmarks include ED coverage, medical directorships, administrative services, hospital-based services, medical staff leadership, telemedicine, diagnostic testing, and clinical hourly rates. Salary and productivity benchmarks are also available and will be updated in the coming months.

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Health care providers use MD Ranger’s benchmarks to set payment rates, document fair market value and comply with federal regulations like Stark and the Anti-Kickback statute. MD Ranger is used by hundreds of healthcare organizations, including hospitals, health systems, trauma centers, medical groups, LTACs, outpatient providers, and critical access facilities.

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The impact of COVID-19 on physician contract payments appears to be variable. Founder and CEO Penny Stroud observed, “Payment rates for most services were surprisingly stable in 2020 despite the pandemic, indicating that hospitals maintained a similar profile of contracted physician services. Notably, 50% of hospital-based physician payments increased, in some cases significantly, due to increased staffing requirements and costs for hospitalists, intensivists and emergency departments during COVID-19 surges and decreased revenue from fewer elective and surgical cases. Telemedicine monthly payments also swelled across multiple specialties.”

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Key findings from the 2021 benchmarks include:

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• Overall, there continue to be more benchmarks that increased than decreased.
• 17% of ED call coverage payment benchmarks declined more than 5% in 2021 compared to only 14% in 2020 while 61% increased compared to 68% in 2020.
• 50% of hospital-based services increased more than 5%, with significant increases in neonatology, psychiatric hospitalists and anesthesia benchmarks.
• While more than half of medical direction payments are within 5% of the prior year, MD Ranger observed more decreases than increases. As seen in the past, hourly rates were steady but annual payments declined due to falling annual hours. 35% of annual hours benchmarks decreased compared to 22% in 2020; conversely, only 31% increased compared to 40% in 2020.
• Telemedicine monthly payments increased more than 50% at the median and the number of hospitals buying telemedicine services in the database increased almost 22%.
• MD Ranger reported more committee payment benchmarks than ever as hospitals signal their commitment to improving both patient and physician satisfaction and quality of care. New benchmarks included “Practitioner Health and Wellness Committee” among others.

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The post MD Ranger’s 2021 Report: New Benchmarks Suggest COVID-19 Impacts on Physician Payments appeared first on MD Ranger.

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Key Updates:

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MD Ranger’s interface was designed in 2011, very early in the proliferation of web products. Updates to the interface were driven to make the overall product more usable, accessible, and mimic conventions used by the majority of internet applications. Users have told us that speed of accessing information is incredibly important to doing their jobs effectively. Our hope is that the changes in MD Ranger will make using the product, as well as training, easier and faster.

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Many organizations use MD Ranger’s automated reports to document FMV. We have streamlined and enhanced the custom report feature by integrating it with the benchmark search feature. Users no longer have to navigate to another section of the product to download or print a customized benchmark report.

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We also made entering and updating physician contract information easier and more streamlined. From the new Contracts feature, users can download automated market rate documentation reports. Our users have reported that having market rate documentation accessible across multiple features was helpful to accommodate different workflow streams.

The post Exciting New Updates to MD Ranger appeared first on MD Ranger.

We still don’t know the full impact COVID will have on healthcare organizations in the long term or short term for that matter. We are hearing about 50 to 80 percent declines in patient volume in the short term and estimated annual declines of 15 to 20 percent depending on the specialty. However, I also think there will be long-lasting changes in how PSAs and a physician compensation are structured as a result of the crisis.

Given the dramatic drop in volume over the past three months, we may see continued shifts away from independent practice and PSAs with clauses to protect against circumstances out of the physician’s control. The impact on value-based payments models is yet to be seen.  Although there may be pressure to move away from productivity-based payment and incentives, the financial pressure is being felt across the industry will make it difficult to significantly change the emphasis on productivity. I also think we will see a surge in physician retirements and mergers with larger groups.

Perhaps the most immediate and dramatic change is the integration and success of telemedicine. As physicians and patients have engaged in thousands of virtual visits, contracts and payment models have been evolving to respond. We expect to see a lot of analysis to set appropriate compensation and productivity standards as telehealth is more fully integrated into physician practices in reimbursement.

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WHAT’S NEW IN 2020

• Physician compensation and production data on 6 new specialties, including:
• Hematology/Oncology: Neuro
• Neurology: Neuromuscular
• Ophthalmology (Nonsurgical)
• Surgery: Plastic and Reconstruction (Oculo)
• Surgery: Transplant (Kidney)
• Surgery: Trauma (Burn)

KEY STATISTICS

Physician Specialties. The 2020 Physician Compensation and Production Survey represents data for 148 different physician specialties, up from 145 specialties in 2019.

Number of Physicians. Data was received on 68,470 physicians, up from 56,625 physicians in 2019 (a 21% increase from 2019).

Administrative Payments. Of the survey respondents who provided a breakout of total cash compensation by component, approximately 19.7% included a separate administrative component of cash compensation. Across all specialties, the average administrative payment was approximately 12.4% of total cash compensation for those who reported a separate administrative payment.

Advanced Practice Provider (“APP”) Supervision Payments. For the survey respondents who provided a breakout of total cash compensation by component, across all specialties the average APP supervision payment earned by physicians was approximately $9,827. It is important to note that this figure does not take into account the number of APPs supervised, or the method of payment (i.e., fixed stipend, payment per Work RVU, revenue less expense, etc.).

Call Coverage Payments. Of the survey respondents who provided a breakout of total cash compensation by component, approximately 12.9% included a separate call coverage component of cash compensation. Across all specialties, the average call coverage payment was approximately 7.8% of total cash compensation for those who reported a separate call coverage payment.

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COVID-19 Spotlight: Leadership Best Practices from MD Ranger on Vimeo.

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We’ve seen firsthand how fast a situation has evolved over the course of the pandemic. So, your organization and its leadership should be ready to respond quickly, decisively and of course effectively to whatever changes could head your way. That being said, a methodical and consistent approach to COVID-related arrangements is very important.

Consider the simplest policy or procedures to promote that consistency. Having the right resources at hand whether that be current market rate benchmarks or robust time reporting products, streamlined negotiations and monitoring. Everyone’s situation is different so you need to evaluate what resources are needed to respond to the crisis and then, just keep reassessing to see if things are working for your organization. An official board-approved policy that enables management to act quickly and in the best interest of the community and organization can provide important structure and documentation for COVID-related contracts and amendments.

Other important ways to engage your board are frequent, regular reports to the board that itemize the organization’s plans and actions. We also recommend creating a board and management task force to monitor actions taken under COVID and provide oversight. Leadership should consistently monitor the financial impact of COVID-related activities on the organization. And lastly, hospital leadership should be communicating very clearly defined expectations of board members and of management to respond to situations that arise as a result of the crisis.

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COVID-19 Spotlight : COVID-19’s Impact on Physician Arrangements from MD Ranger on Vimeo.

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‍ We’ve seen arrangements ranging from adding completely new services to providing backstops for physicians whose office practice volumes fell precipitously. Let me share some examples.

A hospital I worked with created a series of new services to address COVID, including an urgent care and testing site, a mobile unit to visit senior care facilities and a dedicated hotline. The hourly rate for physician services was set approximately 20 percent over the standard rates paid for urgent care. But the physician’s PSA also had to be adjusted to include double payment if hours in the COVID site overlapped and reduced hours required in the PSA.

I’ve also seen increased ICU staffing needs resolved in different ways. In one situation, a contract amendment was needed for an intensivist group to allow per diem payments for additional staff while in another, an anesthesia contract was amended to repurpose anesthesiologists from outpatient surgery to care for critical patients in the ED and ICU.

I’ve also seen a number of medical groups amending PSAs that paid physicians based on productivity due to the 50 to 80 percent declines in patient visits. Compensation plans were adjusted in the short term, with some groups selecting a benchmark-based floor or guarantee and others looking back to historical compensation to stabilize income.

In each of these situations, contracts had to be amended with negotiated payments, performance and length of contract decisions, many of which will require ongoing discussion and revisions. The short turnaround required to execute contracts in response to the crisis was facilitated when organizations had ready access to high quality benchmarks and a designated contract manager who was familiar with existing contracts and could monitor payments and terms.

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COVID-19 Spotlight: Stark Regulation Waivers from MD Ranger on Vimeo.

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It’s important to understand that these waivers don’t impact the vast majority of provisions within Stark and fraud of any kind is still prohibited. So understanding what you can and you can’t do under the blanket waivers is key. Note that the intention of CMS is to make it easier on providers to act quickly and nimbly to respond to the pandemic and not to relax Stark, per se. Because if you’re working at or advising health care organizations right now, you know firsthand that organizations are amending existing contracts or even arranging new ones fast to address COVID.

So, the first thing you need to know is the waivers cover arrangements retro to March one 2020 and are only in effect as long as there’s a public health emergency. New arrangements or payments that fall under these waivers must be solely related to COVID-19. All arrangements do need to have a limited timeframe and scope.

Second, you don’t want to stop tracking physician time activities or payments just because this is a global health crisis. Any and all records must be available and accessible to prove that payments aren’t fraudulent, and you need to keep and maintain those records.

Lastly, and this is something everyone’s been wondering about; payment may exceed or fall below fair market value, but only for arrangements that are related to the COVID response.

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Here are our responses to some critical questions we have been asked by some of our subscribers relating to the unfolding COVID-19 crisis.

Question: Can we increase the hours that are defined in various physician contracts to address our response to COVID-19?

Answer: Yes. The response to a public health emergency is an extraordinary circumstance that can justify waiver of the Stark ‘set in advance’ guidelines.

Question: Can we compensate physicians for higher than our standard hours or hourly rates, if necessary, to secure needed services related to COVID-19?

Answer: Yes. These efforts epitomize the kind of extraordinary circumstances that reasonably allow for normal benchmark limits to be exceeded to secure needed physician services. In standard valuation practice, typical compensation benchmark guidelines are between the 25th to 75th percentile of market rate benchmarks, or in some cases up to the 90th percentile. Your organization should consider its current internal guidelines and determine if conditions require efforts above and beyond standard payment terms.

Question: How should the principle of allowances for extraordinary circumstances be translated into practice?

Answer: Consider and execute the following:

• Adjustments to compensation should be documented as directly connected to the COVID-19 response.
• Adjustments should be clearly defined as temporary with applicability only until the heightened response is no longer required (with a provision for periodic review).
• Work hours and compensation rates can exceed the 75th percentile or even the 90th percentile as indicated by sound justification of the need for services, and prudent negotiations that reflect reasonable judgement.

Question: What service benchmarks are relevant to this extraordinary event?

Answer: This depends on the hospital and how you are responding to the crisis. Some positions that we think may be relevant include infectious disease-related positions, medical directors of service lines such as emergency services, internal medicine hospitalists, OB and critical care. Similarly, hourly rates for urgent care or outpatient clinic staffing may be useful.

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