CHALLENGES
This multi-specialty community hospital has various provider types and many complex variations due to the nature of their 26 specialties, rural location and historical relationships. A very manual and convoluted Excel workbook that contained considerations for 20 different comp plans with separate tabs for each specialty and provider was very difficult and time consuming to maintain. The models include citizenship, quality, patient satisfaction, admin, and production components driven by elements such as wRVUs assignment logic and modifier adjustments, use of APPs, team comp, loan amortization, FTE adjustments, and various eligibility criteria and thresholds. Manual overrides of variable metrics such as wRVU rates and goals were abundant and frequent, and payment calculations had dependencies on citizenship and charge lag data that required manual processing. Quality and patient satisfaction reports were generated independently and manually calculated in Excel with only annual payments occurring due to time and resource limitations. Contract data was highly disorganized and retroactive comp data updates were required. Discrepancies in payments were noted due to an unreliable wRVU assignment process. Key compensation metrics were updated 25 days after month-close and payments were made 60 days after quarter-close thus providers could not track performance trajectory or align payment with performance in a timely manner.

IMPLEMENTATION
Implementation of the ProCARE platform totaled 580 FTE hours over 12 weeks with roughly a third of the time attributed to requirements gathering and analysis. The total time invested by the client was about 120 hours or 21% of the aggregate which was spent mostly on source data extracts and user acceptance testing and validations. The individual structures of the 20 comp plans were streamlined into 2 lowest common denominator plans at scale with the variances addressed through variable comp elements in the platform assigned at various hierarchy levels – specialty/sub specialty, group, team, and provider with ascending levels of precedence, respectively. FMV thresholds were also set up to be automatically evaluated and alerted when breached.

OUTCOMES
After ProCARE Portal was implemented, an 80% reduction in time and effort in managing the end-to-end comp process was achieved. ProCARE also uncovered a $140K quarterly payment discrepancy during parallel testing that would have resulted in an errant payment. The automation of wRVU assignments based on rendering/supervising provider lookup logic and the ability to recalculate compensation based on retroactive changes and generate balances ultimately increased payment accuracy and elevated the trust and confidence of the admin staff and providers. Other benefits resulting from comp automation such as the visibility to timely comp results through dashboards and detailed outputs showing performance trajectory, the linkage between payments and operational/quality metrics and the ability to model and shadow plans will drive the next phase in comp optimization.