AHLA's Speaking of Health Law

Use of Provider Compensation Benchmarks in 2021 and Beyond

December 07, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
Use of Provider Compensation Benchmarks in 2021 and Beyond
Show Notes Transcript

Hospitals and health systems rely heavily on published compensation data for establishing their provider compensation and as part of their documentation for regulatory compliance. A lot of questions have arisen from the recently published benchmarks, related to impacts of the pandemic and comparability challenges associated with implementation of the latest Medicare Physician Fee Schedule. Emma Miller, ECG Management Consultants, speaks with representatives from four of the nationally recognized survey companies about the most recent benchmarks and how the data should be utilized. 

Emma’s panel includes Elizabeth Siemsen, American Medical Group Association, Maria Hayduk, ECG Management Consultants, Meghan Wong, Medical Group Management Association, and Patty Bohney, Sullivan Cotter. 

From the Fair Market Value Affinity Group of AHLA’s Hospitals and Health Systems Practice Group.

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

This episode of HL, a speaking of health law is brought to you by HLA members and donors like you. For more information, visit American health law.org.

Speaker 2:

Hello and welcome to the HLA podcast. Use of provided compensation benchmarks in 2021 and beyond my name is Emma Miller, and I'm gonna be your host today. I'm an associate principal at ECG management consultants focused in provided compensation services. I'm joined today with representatives from four of the nation to discuss the most recently published benchmarks and how the data should be utilized. Us. Health systems rely heavily on published compensation data for establishing their provided compensation. And as part of their documentation of regulatory compliance, a lot of questions have arisen from their recently published benchmarks as they reflect impacts pandemic, and also have comparability challenges with the implementation of the latest medical physician fee schedule, which is what we're gonna dig into today to get started and to cover this topic, I would like to introduce the additional participants in this podcast, Elizabeth Simon firm, American medical group association, Maria hay, duke from ECG management consultant, Megan Wong from medical group management association and Patty bony from Sullivan Carter. Thank you all for joining me today. It would be great for each of you to take a few moments to introduce yourself and we'll do the survey you represent. Elizabeth, would you like to go first?

Speaker 3:

This is Elizabeth Simpson. I'm a director of the survey program for am MGA and the MGA survey has been in place for 34 years. Um, so it's well known in the market, um, has been around for a while and we're excited because the, the 2021 version of the survey, we had 398 groups participate in over 190,000 physician, uh, represented by the data with over 173, uh, provider specialties. So I've been excited to, uh, get into this very unique year, um, and as we head into another and thank you for the opportunity to chat about what it means to the marketplace.

Speaker 2:

Great. Thank you, Maria.

Speaker 4:

Yeah. Thanks Emma. Um, so I am Maria Hatu and I'm an associate principal, uh, for ECG management consultants. I'm responsible for the provider analytics practice within our provider financial services division. Our team and provider analytics are responsible for conducting our annual rider compensation and medical group performance surveys. Uh, we do specialty association and society surveys as well as custom studies as requested by our clients in 2021. We just published our 22nd annual physician and a PPP compensation survey, our largest to date and our 15th annual pediatric subspecialty physician and a P P compensation survey, which, um, contains, uh, 13,000 pediatric subspecialists practicing within pediatric provider organizations across the country. So in addition to the, these studies, we'd have a faculty physician compensation survey, as well as a medical group performance survey, where we publish key financial performance benchmarks for large medical groups, such as revenue staffing, and provider expenses by service line. Um, and then finally, the last thing that we do that we have is a, um, we compile all of the C P T data. We collect for our RVU benchmarks into a C P T data, um, uh, profile tool, which is available to, um, our, our clients via ECG vault, which is our online data tool.

Speaker 2:

Thanks, Maria. Megan.

Speaker 5:

Great. Thanks. Yes, this is Megan Wong. I'm the director of data solutions at medical group management association or MGMA. We're headquartered at just south of Denver, Colorado in our association, we're currently supporting over 15,000 medical groups ranging from small private practices up to large health systems in, in the country and representing about 350,000 physicians and personally, and the data solutions department I've been involved in the provider compensation survey. Since I started as a data analyst back in 2007. And over that time, I've had a chance to project manage all aspects of the MGMA compensation surveys, including the, the private practice survey that most people think of, but also our, a faculty data set are starting salary for providers, data set, as well as the management and staff competition surveys as well. Um, our group, our association has, has been around since 1926, and we've been capturing data in some form, uh, or fashion from that time on from our medical groups. And the, the way that we capture information now is we open up compensation survey starting in January, um, LEDs to medical groups to come and, and submit their data. We run automated trims, and we do a lot of manual reviews by the analysts in our department. Um, and then we produce the first MGMA data dive report and provide our compensations come may a little bit more about the data solutions department, not only as our group, um, crunching numbers and putting those reports and those surveys out, but we have a really strong customer service aspect to us too, cuz we're assisting members and customers and filling out the surveys. We're doing trainings on our day dive platform. And then, um, as we get questions on application of information, we have a strong resources available in our MGMA consulting group. Um, looking at things like compensation planning and fair market value.

Speaker 2:

Great. Thanks Megan. Uh, Patty,

Speaker 6:

Hey, um, uh, thanks Emma. I'm uh, Patty bony, I'm a principal with Sullivan Coter and, uh, am responsible for co-leading our fair market value growth team as well as, um, uh, participate with the development of, uh, the annual surveys. Um, Sullivan co was founded about 30 years ago and we really started with a focus on consult and advisory services to the healthcare organizations and healthcare industry and Sullivan CA has really grown, uh, over the time to be one of the leading independent firms of senior advisors on workforce information and solutions for healthcare and nonprofit organizations. In addition to our three services, our product offerings include a suite of workforce surveys, including it enabled benchmarks 360 and also it enabled performance management and provider needs, assessment solutions. So Sullivan conducts workforce surveys and reports, benchmark data for physicians, advanced practice providers, executives, and employees within the healthcare industry. And we have two surveys, uh, that are utilized for capturing and reporting, uh, physician compensation and productivity data. The first is the physician compensation and productivity survey, which, uh, probably many are, uh, um, uh, have have been exposed to. And this is really the broadest capture of the two surveys incorporates data from over 800 organizations and about 250,000 providers, uh, reporting out for 250 specialties. And the medical group survey is the second, uh, of the two surveys, which captures and reports from approximately 300 large medical groups representing about 190 specialties. We also collect and report more in-depth data every two to three years for hospital based services, call coverage and telemedicine service for the 2021 survey year. Uh, Sullivan co has provided three sets of data to the market. The first reflecting as reported data from 2020, including the COVID impacts a second set of data, a set in consideration of the 2019 data adjusted using trend again, for as to forecast what would have happened had the Pendo been, had the pandemic not have happened. And then finally, um, a set of data that's really been, uh, developed in consideration of the 2021 CMS physician fee schedule to reflect the anticipated changes to key metrics, including compensation, production, and, uh, comp per work rates.

Speaker 2:

Great. Thank you, Patty. And thank you everyone for, for joining. Um, well let's go ahead and get started. Uh, you know, the first question that I wanted to ask, um, was, you know, the pandemic really changed, um, the, the way that data, some of the data has been reported. And so I wanted to, my first question is really how did the pandemic change the way you think about data collection? Megan, do you wanna take a, a pass it, um, take the first response here. Yeah,

Speaker 5:

Absolutely. Thanks. So, um, you know, we were concerned, we were concerned that groups weren't gonna have the resources to come and complete the surveys in 2021. We, we weren't sure what to expect. And while some medical groups did have to opt data participating this past winter and spring, we actually saw more groups come to us and participate than we had before. Uh, our sample for our provider compensation data set grew to more than 185,000 providers across, uh, 6,700 physician own and hospital own groups, which was a 10% growth for us. So we're really pleased. And anecdotally, what we've seen from these groups is now more than ever, they wanna make sure that their information and their groups are being counted, you in the results and they wanna see what the market is reflecting. Um, we conducted the survey in the same ways that we have in recent years. We, we reached out to all medical practices. We urged the importance, uh, for their groups to be filling out the survey. We reached out to pass participants and, and help them along, um, in participating within the survey with their information to make sure that they were being counted and, um, specific to the 20, 21 survey, we had already thought that we needed to start adding some telehealth productivity questions to our surveys and then 2020 happened. And, um, we realized that yes, most everybody was almost forced into telehealth, um, whether they were planning to or not. So we didn't include quite a few questions on that in our 2021 surveys.

Speaker 2:

Great. Thanks. Did anyone else, uh, wanna add, uh, to Megan's response as well?

Speaker 4:

Yeah, this is Maria. So we had a very similar, uh, experience as Megan. We were concerned. We thought, you know, uh, we would hear from our group that they didn't think the data was gonna be useful. Um, but similar to Megan, we saw, uh, an incredible growth in the survey. We had, uh, groups come to us and our groups are, you know, large groups. They all average more than 250 physicians, but really where we started hearing from them was in the spring of 2020. And, uh, as a result of their concerns, we started, uh, we launched a COVID impact study, uh, where we were collecting C PT data from, uh, uh, numerous organizations and looking at, um, how their, uh, providers, their specialties and their medical groups were faring during COVID, you know, uh, what was happening with virtual care. How did, uh, their production in, you know, monthly production change in 2020, uh, when we compared it to 2019. Um, and, and we gave those results out to, to those participants. And what was nice about that? Is it, it helped give us some insight as to what to expect when we collected the broader data set from the, uh, 20, 21 survey members when they sent us the 20, 20, uh, data. So what we, what we did do a little bit different in collecting our data was that added a few questions. We wanted to understand how many groups were protecting compensation to what degree, why they were doing it, what kind of, um, uh, experiences they were having within their group, um, in terms of government actions, um, medical group actions, redeployment, uh, use of apps and things during COVID, uh, uh, so that it would give us the ability to study the data we had, um, uh, with a little bit of, uh, perspective in terms of what the experiences were from our, from our survey members.

Speaker 2:

Oh, go ahead, Patty.

Speaker 6:

I was just say that we, we did actually take a similar, um, similar approach. Um, the one thing that we also did was, um, to request the data by month and, uh, expand the request for participants to provide their data at the C P T level, um, so that we could, uh, gain additional insights from that. So be between, um, preparing for how we were collecting the data, as well as beginning to think through, uh, what we might see when the data became reported and what would be, you know, most useful to, um, the market and the participants in the dataset.

Speaker 3:

And I'll say AMGA, we had a similar experience to what folks have described in kind of that initial apprehension. We had done some pulse surveys with our members throughout 2020, and really trying to understand what they were doing, tactically in regards to compensation and related issues, um, as the pandemic hit. So where were the guarantees going in, um, what were doing, were they laying folks off or furloughing providers and, um, really gave us that picture of, it was, it was hard to get a handle on, on one direction because there were so many directions that people were going. And so we realized that it was gonna be tricky to try to pull the right analytics for that. Um, so as we went into the survey process, we really were like, try I to collect additional information that just gave us context. So we were able to do some additional analysis for our members, um, to say, look without the, the guarantees in place. We think the compensation would've been at level X here. And so we were able to kind of estimate what that looked like, um, for our, our members and get a, a better picture of the impact the pandemic really had.

Speaker 2:

Thanks everyone. It sounds like there was a lot of additional data collected, um, in the last round of, uh, data collection. And a lot of new information is gonna be provided this year. How do, how do you all anticipate the new information being utilized? Elizabeth, do you wanna start off with

Speaker 3:

That? Well, I think it's hard to say because it ends up being historical data. And I think it's a unique time period because we have the pandemic one year and then as we go into next year, we have the a and M code changes. And so it's not one, one event that's causing noise and the data it's too, and they're gonna kind of go different directions. So I think it becomes tricky and it's a unique circumstance to have to deal with these two years in a row. Um, so that's what as we thought about, and we're in our process now to get ready for the 20, 22 survey. And again, making sure we have the right context for the data and that we're able to give our members valuable that they can, can work off of. Um, I think, you know, there's been some discussion about the value of the, of the 20, 21 survey, but we felt it was an important, it is the market data. There are groups out there that were required to use that data and there's value in seeing the trends and what's happening in the marketplace. And that will be the case going forward, um, as well. Um, so again, as we look at it, we use our normal process about what specialties do we add, or we, is there anything else happening in the market that we need to make sure we're capturing, but also then reaffirming that this major event, um, whether it's a pandemic or it's an E and M code change, um, you know, that we're getting the right context so that we can do different analysis and make sure we're PRI providing the right the right insight to our, our members and our clients.

Speaker 2:

Great. Thank you. Um, Maria, Megan, Patty, anything else to add on that?

Speaker 4:

Yeah, I mean that, it's, it's the same, it's, it's the same story. So we are, you know, I think what I think it was Elizabeth that meant, and the variability and what we heard from our members and what their experiences were in 2021. We actually did take our data from last year and looked at it in terms of how COVID impact each market. So we looked at ambulatory professional claims by market, and then looked at our benchmarks to see how they changed. And what we saw is the, at, you know, in, in the markets that were drastically impacted by, uh, COVID, whether it be by stay at home orders or patients staying home, or what have you, uh, you know, compensation fell by quite a bit and RV fell by even more, but in, in moderately affected markets, um, you know, comp was protected to a greater extent. So, you know, we back then the next few years to be, you know, pretty turbulent, you know, for these reasons, the, um, what has already been mentioned with the impact of COVID and the RVU impacts, uh, from the 2021 RVU schedule. What we plan to do is what we've done this year again, which is we're gonna be publishing our VUS and our RVU rates, um, by calculating VUS under both the, the, uh, 2021 RVU schedule in 2021. But we're gonna also publish the supplemental schedules where we calculate the benchmarks using the 20, 20 Medicare physician fee schedule for those organizations that we know of who are holding off for now, uh, might, um, you know, transitioning to the new, um, to the new fee schedule. Uh, you know, we don't take self-reported data. So it's nice for our organizations to have the benchmarks published it either under 20 21, 20 20, we've also are supplying our members with the lag adjusted data. As I heard mentioned, where we are looking at the five year compounded annual growth rate of the benchmarks by specialty category and saying, how, where did we think comp compensation would've landed, had these things not happened? Um, and so, and where would VU comp to work VU have landed, had COVID not happen. And the one request that we've gotten from our members is can you take your, our, your 2020 survey benchmarks lag, adjusted to 2021, but use the 20, 20, 21 RVU schedule to so that we have benchmarks that have been that take, uh, into account both COVID and the RVU change. So, um, you know, we, we expect these things to take three or four years, but we're hoping to publish enough benchmarks that each of our groups will have access to the ones that are most aligned with how they're, uh, incorporating the benchmarks within their compensation plans.

Speaker 6:

Yeah. And I think that for Sullivan co we, we took the perspective that we really had. I mean, there were so many different needs in the market, so a need to study historically, like what happened and what might you look like? What might we learn from that? But also the real needs to be able to evaluate compensation for our fair market value needs, um, and being able to use trended data potentially for that. But then also being able to address that perspective, um, situation where, uh, uh, a, a group or organization may have contractual requirements to utilize the 20, 21, uh, uh, work RVU data or CMS tables. And then we wanted to be able to provide that additional set of data to be able to project what those changes are gonna look like. Uh, you know, what we anticipate that they're gonna look like in the coming year, uh, after that data, the 2021 data is actually processed, which we've ordered out in 2022.

Speaker 2:

Yeah. Patty, that, that brings me to my next question. Um, you know, what are some of the questions that you are most frequently getting asked about the data that has been published and what what's some of the guidance that you're giving in, um, cautions that you're also advising on related to the use of the benchmarks?

Speaker 4:

Um, I'll, I'll just take a step back real quick and mention

Speaker 5:

That MGMA has been capturing data much in the same way that I heard the other group said in 2020, and looking at that information, um, it was new for us to capture it monthly and say, you know, what did compensation staffing revenue, um, all productivity look like monthly and watch the data as it shifted and changed during the shutdowns in 2020, um, the, the information Bo out the same as what our large provider compensation data set Bo that there was, um, relatively, you know, stable to not increasing compensation for the groups that in our sample. Um, and while productivity did decline slightly, we did see some of that pick back up, come the summer months. And the survey that we did was a great opportunity for us to reach out to medical practices and get context from them and hear from them. They were able to leverage things like furloughs or PTO to maintain compensation levels or government stimulus funds, um, which we saw play out when their compensation spiked in August when those government checks hit. So, um, the, we saw a lot of the same things happen in our provider compensation data set, too, that compensation did remain flat, um, with productivity declining just a bit. And, um, you know, people come to us and they ask, they're really curious what the data looks like and whether or not they should use it. And we say the, the same things that the, the other groups are saying, like, it's a proof collection of the market. Absolutely. You should be using this information and users need to be informed and very intentional when they're using that data. So if you're using things like a compensation to work, or B ratio, you have to be very informed that if compensation's staying stable and work or user are going down, that ratio is naturally gonna inflate. And so, um, you know, just urging individuals who are comfortable, if they wanna create blended benchmarks, looking at 2019 and 2020 data to take into account, maybe some of the, the dip in Q2 of 2020 and productivity, but that also kind of some of the, you know, rebounding to where, um, different medical practices are, are today. Um,

Speaker 6:

I would say, um, we've still have many questions about the transition of the CMS, uh, physician fee schedule changes and how to transition, um, how to use the benchmark to, uh, inform their decision about what they're gonna do going forward. Um, and a, probably a fair amount of questions about next year's data, and whether we're gonna see some stability there, and then just being able to, um, understand what the data is telling them and what influences are, are part of the data set and what they need to think about kind of on a go forward basis.

Speaker 4:

Yeah. And Emma, I think where the thing that's unique this year, this is Maria from ECG. What I think is unique this year is how much we have had to coordinate with our fair market value practice and our compensation planning practice in understanding, uh, the situation of our clients and understanding what is our guidance, right? And so, um, and, and I, I believe it was Megan that mentioned the, uh, the contracts that need to be updated, the PSA agreements, the, um, the, uh, physician contracts that have to, uh, be updated on an annual basis using the survey benchmarks that are published and, you know, how do we advise our clients in terms of what to do? And, and with, we are spec to fair market values. We understand that, you know, we are going to go into each one of those FMVs and commercial reasonableness opinions, understanding the unique facts and circumstances for that physician or for that medical group. And, you know, looking at the compensation, looking at what's happened that market look at the, the VUS VU, um, you know, things of the production data, um, and what the trends are in that market in order to, uh, publish an, uh, or offer an opinion on, um, on those arrangements. And so, and we've had to, as our compensation planning team has worked to, uh, update compensation plan designs and looking at VUS VU, threshold and rates, and, and, and taking a look at an existing plan that uses three years of data blended from, um, multiple surveys. And then now you look at these benchmarks and you say, well, COVID impacted these, uh, the VUS were published using different bases or self-reported, um, how do we, uh, you know, the, the production has fallen, uh, you know, what do we advise our clients on? So what we're trying to do in that scenario in this environment is stay consistent, understand the data, take a deep dive, publish multiple data at, um, and make sure that we manage, um, our, our advice to our clients in a consistent way across those three practices to provide guidance.

Speaker 3:

And our experiences is very similar and we get, I be, we get a lot of the same questions whenever I'm presenting or doing webinars. We did have a, a running joke about who would be the first person to ask about the 20, 21, uh, work, however, review changes.<laugh>. Um, but also, I think one thing that hasn't been mentioned is, is we've advised our clients and the folks that we work with too, is it's a great opportunity to work with your providers to make sure they understand the comp formulas and the plan and how it comes together. Because with all of the information about what was happening with either the 20, 21 survey with, um, the impact of guarantees on the market data, um, and the big fluctuations in competition for worker view, but then also going forward with the, the worker view changes and the idea that there was some windfall out there, uh, for some specialties, uh, it is it's getting the conversation going at the medical groups, and it's really an opportunity for them to really understand how the survey works, what the data means and what the, how the benchmarks are used within their individual comp plans. Uh, because there's, there's so much disinformation of about it and lack of understanding, uh, it's created some stories that maybe medical groups don't wanna be in. And so we've really encouraged people to work with their providers and their comp teams, um, and their comp committees to make sure that there is education and understanding going on with their providers.

Speaker 2:

Yeah, that absolutely makes a lot of sense. Um, and so just thinking about, um, looking forward and the next round of survey surveys that are gonna be published, I would be interested to hear from of you about how you're preparing for next year, and then also, um, some additional thoughts around the comparability of the data that will be published in 2022. Maria, do you

Speaker 4:

<affirmative> yeah, sure. I think I touched upon this a little bit, um, earlier, uh, so moving into 2022, we're not going to be doing anything fundamentally different in 2021, we did produce, uh, COVID adjusted benchmarks that were the 2020 survey data lagged forward. We plan on doing the same thing in 2022. Um, one of the things that I mentioned was that we do, uh, calculate our VUS, uh, from C PT level data. So we will be producing since the production data we're collecting is from 2021. That will be our standard benchmarks. They will be 2021 production data calculated, um, against the 20, 21, uh, Medicare physician fee schedule. But because of those organizations who are, um, will remain on 2020 for a while, um, we need to publish those benchmarks too, so that they have, um, have access to that. But we're going to continue to look at the impact by market as well, to see whether what we saw in 2020, um, continued into 2021. We've had different markets with, um, you know, COVID surges, uh, we've had groups evolve in terms of their policies, um, in terms of their, uh, physician retention. Uh, we've seen, uh, B benefits increase in some markets with sabbaticals being offered, uh, different strategies, uh, that may or may not be increasing compensation across these markets. And so we're going to be asking questions, um, to our survey members to try to get a better understanding of what else changed other than what we know, right. We know COVID is impacting the compensation and production. We know the Medicare physician fee schedule, um, of the impact of that, but what else has changed in the market is virtual care seeing, um, you know, going back to where it was pre COVID, um, you know, and, and, and how our benefits changing. So, so that's what we're planning on doing in 2022.

Speaker 2:

Great. Thanks, Maria. Megan, how is MGME preparing?

Speaker 5:

Yeah, much like everybody has been, been talking about, we, we are hearing from medical groups that are having trouble adjusting or not planning to, to shift over to the new fee schedule. So with the 2022 survey, we're making our RVU calculator available to all survey for expense to where they can just give us their CPTs much like, um, others. It said, and we'll, we'll calculate to get everybody on the same fee schedule in our benchmarks. Um, some of the other things that we've heard from our members as well is that staffing is an ongoing issue for medical practices, and they're having to be a premium, um, in fighting to bring in contracted clinical support staff. So in our survey next year, we're gonna have a separate survey specific to those groups who are, um, providing those contracted, uh, staff out to so that we can make sure that our reports are providing the benchmarks for practices so they can stay competitive in the market and, and plan for, for getting the staff and that they need. And finally, something new that we're doing in 2022 is adding, uh, quite a few value based care metrics to our practice operations survey. Um, the ones that aren't really prevalent as benchmarks in the industry today, and our goal with that is trying to get a better picture of the changing reimbursement models and their impact on medical revenue, which essentially, and ultimately is that compensation driver. And so we're thinking that as more groups are shifting over, um, their payments to more of that value reimbursement, that relationship between cost of care medical revenue and that patient attribution, it's gonna take on a greater role in determining compensation. And I've been thinking this for the last few years, but it seems like more and more now that maybe the next five to 10 years, uh, we're looking at value as being the predominant compensation driver are moving us away from, from work, are we use moving forward? So, um, yeah, that's how we were looking for 2022.

Speaker 2:

Great, thanks, Elizabeth.

Speaker 3:

Uh, again, you know, we, we're following our, our usual process as we, we get ready for the start of the year and our data collection period in January, and really looking at our usual process, any new, special, any, uh, additional, um, special circumstances. We wanna make sure that we're capturing information on, but then also, uh, and I think the others have harken into it a little bit and each have a different approach to it, but ensuring that, you know, we're collecting data that is from the right fee schedule for work our views and make, you know, confirming with groups that we collect that data. So whether it is through C PT codes or reinforcing and looking at historical data trends to, uh, work on our validation processes, that'll be a critical piece cuz the market data, you know, will be publishing will be the 20, 21, uh, work RBU schedule. So that's really our focus about making sure that we're connecting people, that the folks that are filling out the survey have the support that they need, um, to reinforce that we're collecting accurate information.

Speaker 6:

Perfect. Thank you. And Patty so much like everybody else, we're gonna be focused on, um, uh, making sure that we've got the a C P T uh, level data, uh, and, and work RVU calculations appropriate to either the 2020 or prior or 2021 or later, uh, fee schedule so that we've got back clear in the data. Um, and, and additional, we're gonna report out both for the 2020 work RVU assumption as well as the 2021 work RVU assumption. Um, there are some other things though that we're gonna be doing in addition to that, um, uh, as we've seen, uh, indications in the pay practices, uh, area of our, our, um, survey, we see that team based model practices are increasing so more along the lines of the value based practice. And also we expect to be able to report, uh, quality payment information, uh, by specialty. So this is something that we've been collecting, um, data on for a few years. And we think that now we've got a consistent, uh, baseline of data to actually be able to, uh, report that out. We're also gonna be expanding our, uh, capture of panel data for additional specialties, uh, beginning in 2022. Uh, and we currently provide and report out for primary care, but we're also going to include, uh, data capture for OB GYN, psychiatry and geriatrics. So just expanding that, um, uh, identification of panel for additional specialties, because we see that being incorporated into compensation planning, uh, for those specialties. So we've got so much going on<laugh> next year. Uh, um, and then we're also looking forward, uh, or anticipating that in 2023 with, um, CMS, um, may also then have additional ENM code changes. So we are also trying to anticipate what we might need, uh, in order to, um, address a potential change, uh, that will be coming or announced, uh, before the 2023, um, calendar year.

Speaker 4:

I wanna add just one thing because, uh, both Patty and Megan touched upon this, and I think it's, it's super important and it's around the value-based metrics and the reporting of those in 2022 and beyond. So, um, and I believe it was Patty that mentioned the primary care panel size and, um, you know, all of our value based metrics really for all of us have been focused around those measurements, you know, for primary care, right? So, you know, risk adjusted panel size on unadjusted, uh, handle size, RAF scores, access, um, you know, quality payments, but really what we're seeing from our clients, especially in our compensation planning, um, practice is around, uh, you know, what, what, how do we measure value for our specialist and what we're trying to do a, a across the board and all of our practice is, you know, we're really trying to just skate to where the puck is. So, you know, we are seeing in our clients, um, huge investments in analytics around, uh, drivers of positive outcomes for different specialists, uh, specialties, you know, for general surgery, for instance, you know, in the past people measure, you know, we reinfection rates or remissions and things that just really aren't great, um, scores to, uh, uh, I mean, they're not, uh, don't allow you to put a lot of money into those metrics because they're not, you know, pure measurements necessarily, um, that you can tie back to one provider. So we're also trying to identify what these metrics are as our clients are investing in identifying, uh, what the drivers of positive outcomes are by specialty, and then including those in our surveys in 2022 and, and moving forward so that we have those measurements that, that our clients are, are looking forward in order to, to incent to a greater extent, you know, specialties beyond primary care.

Speaker 2:

Yeah. Thanks, Maria. It sounds like, you know, everyone's thinking, um, a little bit outside the box in terms of, um, the data that, uh, everyone's clients is gonna be meeting and, and anticipating, um, in the future and that there's some gonna be some great new data and information coming forward in the, in the coming years. So, um, I really appreciate everyone joining, um, and participating in this conversation today and I look forward to 2020. Thanks everyone. Thank

Speaker 1:

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