June 2, 2020
Quantifying PA Productivity Can be Challenging
PA Productivity Should Not be Quantified by Financial Contribution Alone
By Sondra DePalma, DHSc, PA-C, DFAAPA
May 4, 2020
Measuring productivity in healthcare is important to determine contribution to care, revenue generation, and job performance; however, accurate measurement of a health professional’s productivity can be challenging. Variations in practice settings, patient complexity, acuity of care, health care resources, workflow, and care services provided, all affect a healthcare provider’s work and productivity, complicating accurate measurement. PAs are acutely affected when productivity measurements are quantified by financial contribution alone. This is because some work done by PAs may not generate measurable revenue or may be attributed to another healthcare provider.
Lack of attribution of services to PAs who provided them may devalue a PA’s measured “productivity.” This may occur when PAs are not formally recognized as a provider of services, when billing mechanisms allow for services to be attributed to a different health professional, or when PAs contribute to bundled payments. In instances of Medicare’s “incident to” billing, in which the professional services provided by PAs are instead attributed to a physician (claim submitted under the physician’s name and NPI) with whom the PA works, measurement of PA value and productivity is flawed and undervalued. A similar problem occurs for services in a hospital setting that are personally performed by a PA, with a physician performing a percentage of the service, but billed under the physician as a Medicare “split/shared” visit.
PA contribution can similarly be “lost” when services are part of a global surgical package. Because reimbursement for many surgical procedures is bundled into a single payment for all pre-, intra-, and post-operative care, PAs providing pre- and post-operative services may have productivity misattributed to the physician.
When measuring productivity, it is important to ensure the most accurate data is used and to understand limitations in attribution that may skew measurement. Measuring Relative Value Units (RVU), a resource-based relative value scale, or revenue alone may provide an incomplete depictions of a PA’s productivity, particularly when billing mechanisms, such as “incident to” or bundled payments, are used or when PAs provide health care services that are not directly reimbursable (such as triage, care coordination, and on-call services).
Value is more than productivity
While some view value and productivity as interchangeable, they are not the same. Contributions of a health professional other than revenue or volume often provide a more complete and accurate assessment of value. Measures of gross billing, net revenue, patient volume, and RVUs may not account for a PA’s overall contribution. Considering factors such as contribution to practice efficiency, patient satisfaction, and quality and outcome measures, in addition to productivity, may better assess a PA’s value to a practice.
Possible Measures for Value and Productivity
PA value and productivity may be measured by any one or any combination of the metrics in the following tables depending on the unique characteristics of the practice, services rendered, workflow, and other factors.
|Measures of PA Value|
|Value Component||Examples of Measurement||Value Benefit|
|Productivity||See table below||Revenue, practice sustainability|
|Quality & Outcomes||Attainment of quality measures (e.g. BP or Hgb AIC), percentage of patients receiving guideline-directed prevention, hospital lengths of stay, readmission rates, post-operative infection rates.||Improved care and outcomes, value-based payments|
|Patient Satisfaction||Average patient satisfaction scores, percentage of scores in top quartile, subset of overall scores (e.g. provider and care delivery components)||Patient engagement, improved adherence|
|Access to Care||Average time delay until available appointment, percent of patients that can be seen within a certain timeframe from requesting an appointment||Improved care and outcomes, patient satisfaction|
|Care Coordination||Timely responses to patient enquiries via portal or phone, ordering of prescriptions||Patient satisfaction and engagement, improved adherence and outcomes|
|Employee Satisfaction||Employee satisfaction scores, quantitative or qualitative employee reporting||Improved employee engagement, decreased burnout|
|Resource Utilization||Adherence with Appropriate Use Criteria, Ratios of Costs/Outcomes||Value-based payments|
|Measures of PA Productivity|
|Productivity Component||Examples of Measurement|
|Direct Measures of Productivity||Work RVUs, Total RVUs, actual collections/revenue generated|
|Indirect Measures of Productivity||Number of patients treated, number of documentation entries in EHR, portions of global services performed|
|Clinical Measures of Productivity||Hours worked, hours on-call, time spent providing patient education (when not separately payable), contribution to research, participation in quality improvement activities|
Sondra DePalma, DHSc, PA-C, DFAAPA, is director, Regulatory and Professional Practice at AAPA. Contact her at [email protected].