299 - Impact of Enhanced wRVU-based Incentive on Academic Pediatric Clinical Productivity

Publication Number: 299.5327

Janette Lee, University of California, Davis, School of Medicine, Sacramento, CA, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Brittney Phillips, University of California, Davis, School of Medicine, Sacramento, CA, United States; Satyan Lakshminrusimha, UC Davis, Sacramento, CA, United States

Background: Some academic pediatric departments provide incentives for clinical productivity based on work relative value units (wRVU) above a prespecified percentile benchmark. The effectiveness of such incentives in academic pediatrics is not known. The Weber-Fechner law states that perception of an incentive is based on its size relative to base pay.

Objective: Determine if an increased $/wRVU incentive is associated with increased clinical productivity in inpatient and outpatient pediatrics in an academic department.

Design/Methods: The Department of Pediatrics at UC Davis instituted an incentive for wRVUs above median benchmark corrected for clinical FTE (cFTE). We compared wRVU/cFTE by division to CPSC (Clinical Practice Solutions Center) benchmarks for fiscal years 2016-17 through 2023-24. The first period of 2016-21 had a lower $/wRVU incentive ( <$10/wRVU) vs 2022-24 which had a higher ($20$/wRVU) incentive. For each specialty and year, we computed the ratio of the UC Davis wRVU per cFTE to the corresponding CPSC median wRVU per cFTE. We log-transformed these ratios to stabilize their variances and fit a fixed-effects linear regression with main effects for specialty and a binary indicator for being in the incentive period, with robust standard errors. Data were expressed as geometric mean ratios (Stata SE/18.0).

Results: Figure 1 shows the geometric mean ratio of UC Davis: CPSC wRVU per cFTE separately for the <$10/wRVU- and the ≥$20/wRVU-incentive periods by specialty. Among inpatient divisions, PICU and hospitalists showed significant increases in productivity/cFTE. Neonatology showed a significant decrease, as this change coincided with a shift to in-house night coverage leading to increased faculty. Low-performing divisions such as general pediatrics and GI significantly increased productivity. Most outpatient performers had high productivity compared to national benchmarks during both incentive periods. Two divisions (nephrology and endocrine) significantly decreased their productivity, perhaps due to recruitment of junior faculty, but remained above national benchmarks.

Conclusion(s): The increase in $/wRVU incentive was effective in increasing productivity in underperforming divisions. High-performing divisions, for the most part, sustained their productivity. Our results support the Weber-Fechner law, with higher incentives promoting higher productivity. However, further studies on the impact of such incentives on physician wellness should be conducted.

Figure 1
The geometric mean ratio of UC Davis faculty productivity (UCD) to National Benchmarks for Inpatient (A) and Combined Outpatient and Inpatient (B) Divisions. The vertical hyphenated line represents increase in incentive from <$10/wRVU to >$20/wRVU. Black * indicates significant increase in productivity and red * indicates significant decrease in productivity with higher incentive.