From the November 2019 issue of HealthCare Business News magazine
Year-over-year, radiologists saw a decrease in absolute cash compensation ranging from -1.0 percent for diagnostic/non-interventional to -8.0 percent in neuro-interventional. For neuro-interventional radiology, sample size may be a factor in the data (n=103 for compensation in 2019). These programs are expanding, and in the future we anticipate a larger number of physicians will report into the survey.
Compensation decreases for radiology are even more astounding given that wRVU production increased for two of three radiology specialties — and the increases were greater than 4 percent. Given the growing reliance on capitation and bundled payments, it may be that employers and payers are devaluing individual diagnostic services in order to keep costs down without sacrificing quality.
Another possible explanation for the trends we saw may be that a clash between the health care industry’s growing emphasis on value and radiologists’ reliance on expensive imaging technology is causing a decline in median wRVU production. Value-based models simultaneously call for the delivery of preventive care and lower costs. However, in the case of comprehensive stroke programs, the need for neuro-interventional radiology presents a Catch-22. Given their somewhat limited use, neuro-interventional radiologists may not be capable of producing the volume necessary to sustain a predominantly production-based compensation model. However, to retain their vital services, it may be that health systems are opting to salary certain radiology subspecialists.
A third factor that may be affecting compensation is the way in which many radiologists choose to economically align themselves with hospitals or health systems. Radiologists often prefer to operate under an independent practice model with a service agreement between themselves and a hospital, rather than integrate with the hospital as an employee. In these affiliation agreements, physician compensation distribution may be based on something other than compensation per wRVU generated (i.e., compensation may be time- or shift-based). Regardless, decreases in overall cash compensation, especially to this extent, are likely not tolerable to radiologists so it will be interesting to observe how the market adjusts in future years.
