University of Wisconsin–Madison Medical College of Wisconsin

Does a Change in Physician Compensation Lead to Changes in Care Delivery in Family Medicine Clinics?

Jennifer Lochner, MD; Jen Birstler, MS; Maureen A. Smith, MD, MPH, PhD; Paul Rathouz, PhD; Brian Arndt, MD; Mark Micek, MD; Elizabeth Trowbridge, MD; Elizabeth Perry, MD; Sandra Kamnetz, MD; Nancy Pandhi, MD, MPH, PhD

WMJ. 2022;121(4):280-284

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Background and Objectives: Many highly capitated systems still pay physicians based on relative value units (RVU), which may lead to excessive office visits. We reviewed electronic health records from the family medicine clinic panel members of 97 physicians and 42 residents to determine if a change from RVUs to panel-based compensation influenced care delivery as defined by the number of office visits and telephone contacts per panel member per month.

Methods: A retrospective analysis of the electronic health records of patients seen in 4 residency training clinics, 10 community clinics, and 4 regional clinics was conducted. We assessed face-to-face care delivery and telephone call volume for the clinics individually and for the clinics pooled by clinic type from 1 year before to at least 1 year after the change.

Results: Change in physician compensation was not found to have an effect on office visits or telephone calls per panel member per month when pooled by clinic categories. Some significant effects were seen in individual clinics without any clear patterns by clinic size or type.

Conclusions: Change in physician compensation was not a key driver of care delivery in family medicine clinics. Understanding changes in care delivery may require looking at a broad array of system, physician, and patient factors.

Author Affiliations: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wisconsin (Lochner, Smith, Arndt, Perry, Kamnetz); Primary Care Academics Transforming Healthcare Collaborative, UW Health, Madison, Wis (Lochner, Smith, Arndt, Micek, Trowbridge, Perry, Kamnetz, Pandhi); Department of Biostatistics and Medical Informatics, UWSMPH, Madison, Wis (Birstler); Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas (Rathouz); Department of Medicine, Division of General Internal Medicine, UWSMPH, Madison, Wis (Micek, Trowbridge); Department of Family and Community Medicine, University of New Mexico Health Sciences Center, City, New Mexico (Pandhi).
Corresponding Author: Jennifer Lochner, MD, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715-1896; phone 608.263.4550; email; ORCID ID 0000-0001-9319-1499
Acknowledgements: The authors wish to thank Peter Nordby and Mindy Smith for editorial support and comments on earlier drafts.
Funding/Support: This project was supported by the Health Innovation Program, the University of Wisconsin School of Medicine and Public Health, from The Wisconsin Partnership Program, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR) through the National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427.
Financial Disclosures: None declared.
Presentations: North American Primary Care Research Group Annual meeting, November 2018.
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