Abstract 11828: Productivity Targets and Performance Reviews for Cardiology Practices in the Veterans Health Administration: Do They Work?

Abstract

Introduction: The optimal mode of promoting physician productivity in integrated healthcare systems is unknown. In 2013, the Veterans Health Administration (VHA) introduced a program setting productivity targets for specialty practices based on the ratio of total work Relative Value Units (wRVUs) to clinical full-time equivalents (FTEs). Practices with productivity less than 1.25 SDs below the mean for their complexity group were required to undergo annual performance reviews and develop remediation plans. Hypothesis: We hypothesized that performance reviews were associated with increased cardiology practice productivity and clinical volume. Methods: We extracted productivity metrics for 125 cardiology practices from fiscal year 2012-2019 reports. We used linear regression to assess the association of reviews with changes in productivity, clinical volume, and access measures, controlling for practice-level trends. Results: Performance reviews were associated with a 38% (95% CI 29 to 47%) relative increase in cardiology practice productivity in the year following review. In the year before review, these practices experienced a relative productivity decrease of 24% (95% CI -35 to -14%), suggesting the observed effect was not due to regression to the mean alone. Reviews were associated with a relative annual increase in practice wRVUs of 29% (95% CI 15 to 44%), a decrease in reported clinical FTEs of 12% (95% CI -24 to -1%), an increase in clinical encounters of 32% (95% CI 16 to 49%), and an increase in the total number of patients receiving care of 23% (95% CI 9 to 36%). There was no significant association between reviews and the annual change in the percentage of new or established patients waiting more than 30 days for an appointment. Conclusions: A program of productivity targets and reviews of low-performing practices was associated with increased cardiologist productivity and total wRVUs, clinical encounters, and number of patients receiving care at reviewed practices. Programs setting productivity targets for groups of specialist physicians may be an effective way to increase care efficiency in integrated healthcare systems. Future research should investigate the impact of these programs on care utilization, appropriateness, and quality.