Doctors up in arms about South Carolina hospital's plans to link pay to patient volume

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Medical University Hospital of South Carolina plans to change the way doctors are paid, starting July 1. (Photo by jansucko/iStock/Getty Images Plus/Getty Images)

Starting July 1, the Medical University of South Carolina (MUSC) plans to link doctors’ pay to the number of patients they treat—a change that has infuriated physicians.

The Charleston hospital will change the way it pays about 1,000 of its physicians, with paychecks reflecting the number of patients they treat rather than the amount of money each hospital department generates, according to The Post and Courier.

One doctor, who asked to remain anonymous, told the newspaper physicians are "livid" at the news. He is concerned that doctors will be forced to see as many patients as possible and that quality, including the amount of time a doctor can spend with each patient, will decline.

Ironically, the change comes at a time when physician payment systems are moving away from volume-based pay to value-based pay.

The healthcare industry’s shift toward replacing payment models that reward providers for the volume of services they provide got a sharp boost from the release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule in late 2016, which codified the federal government’s transition to value-based care.

The publication reports that at the MUSC Board of Trustees meeting last week, Medical University Hospital CEO Pat Cawley, M.D., acknowledged that some doctors are unhappy about the changes. "High producers" who meet their goals won't be penalized, but doctors who have not been the most "clinically productive" are "going to have a tough time," he said. But doctors must be accountable for their clinical productivity.

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A doctor’s productivity, as measured by relative value units (RVUs), is a significant factor in many compensation packages. Most clinical departments at MUSC already track and set goals for their physicians’ RVUs.

Hospital officials told the newspaper that the new pay system will correct inequities in the current setup, in which doctors' pay is based mostly on how much money their departments generate. So, for instance, trauma surgeons, who often treat low-income or uninsured patients, might not generate as much money as others.