1. DOM AY18 Clinical Faculty Compensation Committee Report
Alice Jacobs, Chair
Eric Awtry
Heidi Auerbach
Jesse Bhatia
Frank Farraye
Eva Greenwood
Eugene Kissin
Phil Knapp
Naomi Ko
Fred Little
David Nunes
Cassandra Pierre
Shwetha Sequeira
April 24, 2017

2. Charge/Goal
Distribute available resources in a manner that is fair, transparent, and aligned with department values and missions
Create an affordable, simple, and understandable framework for recognizing faculty and section clinical performance
Create aspirational and achievable goals for the department’s clinical performance that are firmly based on the financial constraints of the department
Recognize achievement in a range of quantitative and qualitative performance measures
Recognize performance in areas that have the greatest positive impact on the department’s quality of care, financial performance, and academic missions
Provide disincentives for performance that adversely effects quality of care and financial performance
Create a shared benefit in the success of the section
Maximize faculty compensation relative to benchmarks
Recognize the variety of determinants of faculty productivity
Recognize the diversity of clinical and academic activities of faculty 

3. Process Informal survey of the faculty in each section:
How would you prefer to be recognized (time or financial reward)?
What is a meaningful bonus?
What non-wRVU activities should be rewarded?
Would you perform more clinical work (clinics, service, weekends) if compensated?
If more ancillary services were provided to help you complete your clinical work, would you forego a personal bonus?

4. Process
Reviewed and discussed the FPF Compensation Principles and the Incentive-Based Performance Measures, and the AY 16 DOM Clinical Compensation Committee Report and Recommendations.
Reviewed the DOM AY17 and multiple other FPF department compensation plans
Reviewed the literature on compensation plans and the report on Physician Compensation Trends and Re- Design prepared for the FPF by Sullivan Cotter in 2015
Met separately with Dr. Bill Creevy, CEO of the FPF, Dr. Steve Christiansen, Chair of the FPF Faculty Compensation Committee and Dr. Coleman.

5. Process Compensation Model: Continue the base salary plus model versus
Total flexible salary model (“Eat What You Heal”)??
Reviewed modeling performed by Eva Greenwood’s team for specific sections putting variable amount of salary at risk and normalizing to academic rank and insurance plans (using wRVUs).

6. Overview of Faculty Survey Results
50% faculty prefer to be recognized by time (off) and 50% by financial reward.
Current incentive not meaningful but definition of meaningful varies.
Non-wRVU activities that should be rewarded are primarily academic endeavors.
Most faculty would not want to do extra work even if compensated.
Most faculty would not forego a bonus for additional ancillary services (that should be provided). Ancillary services considered insufficient included staff (nurse and MA), IT and interpreter support, working computers, EPIC optimization.

7. Discussion
Given the limited funds available for incentive payments, committee embraced the concept of “bonus” rather than true incentive.
Committee acknowledged the current financial realities and that since payment per wRVU is linked to clinical revenue which forms the basis of our budgets, wRVU-based targets are a necessity. In the future, there will likely be alternatives to wRVU targets as we move away from fee for service care models.
In view of the relatively low (below the 25th AAMC northeast salary benchmark by specialty) faculty salaries in several sections, committee was uncomfortable lowering base salaries to provide additional incentive funds or putting salary at risk to fund an “Eat What You Heal” model.

8. Discussion
Committee noted that many faculty think the current disincentive policy is demoralizing and it is resented although rarely used. While the wisdom of providing disincentives for poor performance was recognized, it was thought that the policy should initially be supportive rather than punitive (particularly since low wRVU performance is often related to issues out of physician control).
In view of the relatively small incentive payments, there was some enthusiasm for considering alternative rewards such as a reduction in cFTE and extra vacation time.

9. Recommendations Cost of Living Increase (COLA):
COLA should be maintained (not forego COLA to increase incentive pool) using existing eligibility criteria:
Meet wRVU target
Hired before January 1
Equity increase less than COLA

10. Recommendations Bonus Model:
The bonus should be paid with a DOM and FPF approved amount within the section using the 50:50 formula of section wRVUs/total department wRVUs and section cFTE/total department cFTE that has been used in past years.

11. Recommendations
The bonus should be based upon productivity (wRVUs) and “citizenship” activities.
The productivity bonus should be paid with between 65% and 85% allocated bonus funds. This percentage is reserved for the discretion of the Section Chief.
The productivity bonus should be proportional to the ratio of the wRVU achieved / wRVU target and the cFTE effort.
Between 15% and 35% of the bonus should be paid to reward non-wRVU activity.
It is suggested that only faculty in the top half of wRVU based productivity (wRVU O/E) receive a wRVU-based bonus or alternatively, a wRVU O/E cut-point should implemented.

12. Recommendations Suggested non-wRVU Criteria include:
Teaching not otherwise compensated for, including fellows, house-staff and students
Service/Committees – service to BMC, DOM and/or section, on committees above what is expected for a given section/department role
Quality Improvement Projects aligned with a section-wide quality goal in one of the following department priority areas for AY18 (increasing access by adding additional clinic sessions above target, reducing readmissions, optimizing transitions of care, high impact specialty-specific evidence- based quality/performance measures, improving patient experience) 
Implementation of New Programs above what is expected for a given section/department role

13. Recommendations Disincentive/Salary Reduction:
The current disincentive at 90% productivity (wRVU O/E <0.9) should remain. Currently, there is an “out” clause that allows sections meeting their budgeted wRVU target to forego penalizing faculty members who are <90% productive. This “out” should be removed.
If a faculty member is <90% productive, he/she should be referred to a remediation committee with the intention of modifying behavior or errors that caused a low productivity. This remediation can range from billing review, providing a section dashboard, onboard training, or other support activities.
The faculty member has a 1 year grace period in which to modify the low productivity. If at year 2 the productivity is <90%, a salary reduction should be incurred using the current policy.

14. Recommendations Criteria for Individual Faculty Eligibility for Bonus:
Individual faculty NOT meeting ALL of the following criteria will be ineligible for bonus:
Individual wRVU target is achieved during AY 18
Number of clinic work weeks is ≥ 45 four hour sessions per assigned weekly session
Compliance with signing of DOM Outpatient Billable Encounters Policy (EPIC Red List):
Clinic cancellation rate ("bump" rate) within 30 days ≤ 3%
Compliance with DOM Inpatient Billing Policy (Patient Keeper Late Billing List)
Compliance with EPIC In-Basket maintenance policy when available
Compliance with Meaningful Use requirements

15. Recommendations Salary Equity:
As in the past, efforts should continue to bring all faculty salary up to at least the AAMC 25th percentile of rank and subspecialty in the northeast and to continue to explore separation of salary from rank.

17. Recommendations
Faculty with wRVUs below 90% of the target for two consecutive years should be subject to salary reduction in the following year.
Salary will be reduced in the following academic year by 2% per 1% below 90% of wRVU target prorated to clinical effort.
Faculty subjected to salary reduction can restore full base salary by the start of the following academic year by increasing wRVUs to an amount over target equivalent to the deficit from the prior year.
Salary reduction will not:
exceed 20% of total compensation
apply to faculty in the first two years of their appointment
be fully executed for faculty at or below the 25th AAMC northeast salary benchmark by specialty.