Provider Pay, Productivity Trends in 2021 Diverged Widely from Previous Year
Impact of pandemic recovery and new CMS coding leads to unprecedented change in survey results
Alexandria, VA – Provider compensation and productivity began to return to normal in 2021 following disruptions from the COVID-19 pandemic the year before, according to AMGA’s 35th annual Medical Group Compensation and Productivity Survey.
While provider compensation increased overall, with the volume of services again rising to pre-pandemic levels, compensation per work unit (wRVU) declined in 2021, where providers were compensated 11.0% less for each individual unit of work in 2021 than they were in 2020.
“This compensation median indicates provider pay is returning to normal now that the salary guarantees we observed during the early phases of the COVID-19 pandemic are no longer in use to the same degree,” said Elizabeth Siemsen, AMGA Consulting director. “The compensation per wRVU ratio’s decline was expected as a recovery from the sharp increase of 10.8% in the 2021 report. This decline reflects both a recovery from the pandemic’s impact on compensation and clinical volumes and the impact of the CMS wRVU changes implemented in 2021.”
The survey shows median provider compensation increased by 3.7% from 2020 to 2021, compared to a minor 0.1% increase from 2019 to 2020. Meanwhile, productivity, as measured in median total wRVUs, increased by 18.3% from 2020 to 2021, compared to a 10.2% decrease the year prior. Consequently, the median compensation per wRVU ratio declined by 11.0% from 2020 to 2021, meaning the compensation associated with individual units of work was lower in 2021 than it was the year before.
“The Centers for Medicare & Medicaid Services (CMS) made significant changes to its wRVU schedule in 2021, which makes an apples-to-apples comparison between 2020 and 2021 more challenging than in years past.” said Fred Horton, M.H.A., AMGA Consulting president. “For this year’s survey, wRVU values were collected using both the 2021 CMS wRVU weights and the prior year values. We analyzed the data in a manner that isolates the differences between volume increases and increases attributable to the new coding weights. The data reported suggests that there was an 11.1% increase in production associated with the volume recovery from the pandemic and an additional 7.2% increase due to the wRVU weight changes.”
“We were able to isolate the two impacts since we collected our data on both a 2020 and 2021 basis. The value in having both sets of wRVU data ensured accuracy in the results and provided a deeper insight into the market trends. There was significant variety in how groups transitioned their compensation plans to take into account the new wRVU weights,” Horton said. “As a result, given the combined exponential impact of recovery, plus the new weights, medical groups must be careful to utilize both a correct methodology and correct data when managing their provider compensation plans.”
“Overall, this year’s survey provides an important new baseline for understanding Medicare's 2021 wRVU schedule change, volume recovery from the COVID-19 pandemic, and other factors impacting provider compensation,” Horton continued. “I would suggest that this is likely the most significant release of our survey in its history. The data reflects what has occurred during the unprecedented pandemic, coupled with a major CMS coding change. Never before have we seen similar aspects impacting the metrics that drive provider compensation.”
The details on the following specialties reflect both the impact of pandemic volume recovery and the impact of the wRVU weight change. The medical and surgical specialties utilized in these charts are not comprehensive. The full survey contains data on 177 specialties.
PRIMARY CARE Change from 2020 to 2021 | |||
Type | Compensation | wRVUs | Compensation per wRVU |
Family Medicine | 3.5% | 25.2% | -17.1% |
Internal Medicine | 3.5% | 28.3% | -16.6% |
Pediatrics and Adolescent - General | 1% | 14.9% | -13.3% |
All Primary Care | 3.0% | 24.1% | -16.2% |
SELECT MEDICAL SPECIALTIES Change from 2020 to 2021 | |||
Type | Compensation | wRVUs | Compensation per wRVU |
Cardiology | 4.2% | 12.0% | -5.2% |
Gastroenterology | 4.2% | 19.2% | -9.1% |
Hematology & Medical Oncology | 4.3% | 17.1% | -15.9% |
Neurology | 3.7% | 18.2% | -9.6% |
All Medical Specialties | 4.1% | 14.7% | -7.4% |
SELECT SURGICAL SPECIALTIES Change from 2020 to 2021 | |||
Type | Compensation | wRVUs | Compensation per wRVU |
OB/GYN (General) | 4.5% | 13.1% | -7.7% |
Emergency Medicine | 1.8% | 9.2% | -9.3% |
General Surgery | 4.5% | 11.3% | -2.2% |
Orthopedic Surgery | 4.7% | 25.4% | -11.6% |
All Surgical Specialties | 3.9% | 11.8% | -6.7% |
ADVANCED PRACTICE CLINICIANS Change from 2020 to 2021 | |||
Type | Compensation | wRVUs | Compensation per wRVU |
Nurse Practitioner (Primary Care) | 4.4% | 27.6% | -19.2% |
Physician’s Assistant (Primary Care) | 5.6% | 34.3% | -20.2% |
NP - Medical Specialties | 3.1% | 27.3% | -19.9% |
PA - Surgical Specialties | 2.8% | 23.8% | -18.0% |
Advanced practice clinician (APC) compensation followed a similar pattern to that of physicians, where median compensation was higher in 2021 than in 2020, wRVUs were significantly higher in 2021 than in 2020, and compensation per wRVUs was significantly lower in 2021 than in 2020. APCs were also more impacted by reduced hours and compensation reduction during the early stages of the pandemic, when compared to physicians, which is an additional variable that may contribute to the change in values in the 2022 report.
“The trends observed among APCs are not surprising. Given the overall lower volume observed throughout most of 2020, many organizations reduced their utilization of APCs,” Horton said. “Now that volume has returned to pre-pandemic levels, APC utilization is returning to pre-pandemic levels as well. Additionally, given the cognitive focus of APCs, the CMS changes to E/M weighting also resulted in additional production for APCs.”
About the Survey
The 35th edition of the AMGA’s Medical Group Compensation and Productivity Survey contains data from 383 medical groups, representing over 183,000 providers from 177 physician, advanced practice clinician, and other specialties. Learn more about the survey here.
###
About AMGA Consulting
AMGA Consulting assists healthcare organizations in navigating the changing industry environment. AMGA Consulting builds clients’ organizational capabilities through effective governance, operational improvement, strategic alignment, talent management, provider compensation design, fair market value analysis and total rewards solutions.
About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.