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Three studies have evaluated alternatives to volume-based physician productivity measures for outpatient medicine specialties. The VHA is ideally positioned to advance this field by developing and testing innovative models to measure physician productivity in the VA setting.
Most US health care systems including VHA use work relative value units (wRVUs) as a surrogate measure for physician work output given the lack of another standard measure. However, physicians have expressed concerns about the mismatch between wRVU data and actual physician work, which involves many activities conducted outside of a billable visit. Productivity metrics based on wRVUs also reward health care volume, rather than value, and do not incorporate patient-important outcomes.
Three observational studies met eligibility criteria. Two observational studies of cardiology practices proposed modifications to work input measures but still used volume-based measures for work output. A third observational study developed a promising a new productivity model using VHA primary care data that integrates clinic-level outputs with important patient outcomes including quality, access, and experience. As a learning health care system that is not dependent on wRVUs for payment, VHA is ideally positioned to develop and test innovative models to measure physician productivity. Two of the 3 studies identified were conducted within VHA, suggesting that VHA already has the data and expertise to advance this field.
