Welcome to the Becker's Healthcare Podcast.
I'm Elizabeth Gregersen, a reporter here at Becker's,
and I'm thrilled to interview
doctor Vinay Boudoir,
executive chair of the WVU Heart and Vascular
service line at WV Medicine
and professor and chairman of the department of
cardiovascular
and thoracic surgery at West Virginia
University.
Doctor Bidoir, thank you so much for joining
me. I'm so excited to chat as we've
just recently connected
for an editorial piece
where we discussed how WV Medicine
Heart and Vascular grew from 225,000,000
to 2,000,000,000
by ditching RVUs.
And I think it's, you know, a conversation
and
insight that readers of any special or t
or any audience members from any specialty,
will appreciate. So I'm grateful to you for
taking the time to, to speak with us
again.
Well, thank you so much, Elizabeth. It's a
pleasure to be with you. And, of course,
the success of a service line is not
only
based on ditching RVUs as you point out.
There's a lot more to it as you're
sure your listeners and viewers know.
Absolutely. Before I hop into my questions,
could you just give a brief introduction of
yourself and and where you're coming from?
Of course. Sure. So, my name is Vinay
Badwar. I'm
a cardiac surgeon by practice,
but, I've been humbled to be over the
WVU Heart and Vascular Institute and service line
since 2016.
And we commenced this service line concept, which
is different than the
traditional service lines
in that the service line is a physician
based,
focus
as opposed to the hospital
looking at hospital revenue cycle,
or hospital based or HB revenue cycle.
The terms, I'm sure your readers are quite
familiar,
and focused only on the PB side or
physician based.
And in this enterprise,
due to the
support
of the system,
the
HVI or the Heart and Vascular Institute
is both.
And we can talk more about that as
we we we proceed here in this, this
conversation.
Perfect. So, yeah, I guess jumping right in
then,
this move happened nearly a decade ago, moving
the entire team off of that RVU based
compensation.
I'd love to know, you know, what exactly
did that shift entail, and and how did
you make it work?
Well, that's a great question.
I I would say that I would answer
that sort of three
different points. First
is that you have to have the right
structure.
And that structure I was leading into when
I was making my comments a moment ago
is that not only is it the
facility,
the ability to hire,
the ability to,
work in an integrated way with the support
staff,
but but also to have oversight over both
the PB and HB side of the house.
And,
that's one important
element.
The second
really is trust
and a tight collaboration
across our administrative
structure,
starting first and foremost with our CEO, Albert
Wright, who's been a ardent supporter of both
the vision and execution of the service line,
and our vice president executive dean Clay Marsh,
who
is the physician champion
over our,
medical enterprise in the School of Medicine.
And
starting with
that collaboration,
I think, is really critical
because we align
in in our thoughts and visions
of how the service line should work and
function.
Then, of of course, also
the overall board of the hospital
and its chair, which is actually the president
of our university. So that's the second. And
the third and final thing is to really
obtain buy
in across the remainder of the leadership enterprise
from the CMOs, the CFOs,
and most importantly, of course, all of the
faculty and physicians that,
and and even allied health providers that, work
within our service line structure.
Hopefully, that begins this conversation. Now to take
it to scale, of course,
as you said,
it takes a little bit more, and it
requires real careful and,
I'd say methodical
stream of communications
as well as data.
Communications
to the faculty at first, of course, to
ensure that they,
feel empowered to have the freedom, but also
the focus on evidence based care.
And then data on volumes, revenues to ensure
not just that our my
administrative team,
but also myself,
actually watch the,
dot the i's, cross the t's, watch the
RVUs,
as well as the financial performance
while allowing our
physicians and APPs to work most effectively.
Now that's that's really important when it comes
to,
fortifying
the heart team concept.
As you know, this is a cardiovascular
service line. And so that has to do
with complex coronary disease heart teams, structural heart
disease heart teams, and, of course, patients with
end stage heart failure.
And so that that way of communicating back
and forth are really,
is very important. And so I don't,
push the RVU performance on our docs.
I watch that along with our administrative team,
and we make sure that we adequately balance
that as we take it to scale.
That's how we began
and continue to maintain.
Perfect. Thank you. I, you know, I can't
not mention while I have you here on
the podcast
that WV Medicine's Heart and Vascular Institute
is in the headlines quite frequently. Your team
performed the world's first robotic transcatheter
aortic valve replacement
explant
and aortic valve replacement, the world's first combined
robotic aortic valve replacement and coronary artery bypass
operation.
You know, I know that your team delivered
nearly 450,000
patient visits in 2024.
So at the same time,
you're you've eliminated our views, and the performance
is still, you know, hitting all the metrics
and and breaking records. So I'd love to
get your perspective on how you feel this
model maybe drives performance and quality on the
ground and in the operating room.
Well, that's very insightful. I appreciate your recognition
of, our team's development.
You know, it's we're having a a good
time.
By by doing that remember, our our service
line includes
all of cardiology, cardiac surgery, thoracic surgery, vascular
surgery, and in our,
main campus, cardiovascular critical care.
So to be able to do all of
these things
and then to go back to your previous
question to additionally scale this,
that it's accounting for productivity
and financials,
but in the aggregate.
Now Now what do I mean by that?
That let's let's be honest. We we all
acknowledge that some of the services, and for
that matter, some of the physicians have different
RVU performance, and we need to account for
that.
As managers or leaders of the of this
portion of the health system,
and we have a, for example, a blended
urban and rural health system as you know.
And so we need to account for things
like windshield time, telemedicine,
and some of our providers that do a
great job
managing
patients in this way, but they don't necessarily
generate high RVUs.
But they're very valuable, so we value them.
And such as, you know,
cardiologists, for example, in the outfield,
you know, throwing the the the balls into
the infield for the, you know, cardio the
interventional cardiologist to catch, so to speak.
And and by
looking at all of the performance of the
entire thing
integrated
and being able to do that carefully is
how we're able to not only continue to
innovate,
but to continue that financial performance. And,
like many systems, we utilize
Epic as our Mhmm. Our medical
as well as as well as our financial
holistic resource for information
to ensure real time
interoperability
across the system in order to solidify our
efforts as an integrated clinical and financial
delivery system.
So enable us to
have our docs and our teams
concentrate on the next
thing.
You mentioned robotics and but there's, we're also
a top enroller in many clinical trials.
You know, sometimes that's a lot of effort
that takes to work on clinical trials and
being able to bring that to our population.
And and that takes time. And allowing our
docs to have the time to do that,
I I think is a
an important
flywheel of success, if you will.
Absolutely. So kind of shifting to that value
based care model has Correct. Has freed up
and kind of opened up the opportunity
for more growth and more innovation.
Absolutely right. I I think if you have
the right minded physician workforce,
you had said, does this you know, how
does it work on the ground? I think
that's really the key. And if you recruit
thoughtful and,
shall I say, quality first physicians that are
committed to
that whole concept, but also are energized to
work hard,
not for the RVUs,
but for the patients and doing the right
thing for the right patient at the right
time.
I know that sounds
somewhat too good to be true, but the
simplicity
of the model
works. When you hire good docs and you
remove as many of the nonclinical influences to
practice as possible,
the majority
of the physicians flourish.
And so part of the reason how we
help make that work
is while we value productivity, of course,
we consider that a little bit on the
bonus side of things. So
we pay salaries,
usually
at or
above the appropriate market based on their level
of
skill and, many years in practice and how
they're gonna contribute to the to the,
enterprise.
And then at the end of the day,
they're not expecting it, but I usually focus
on a bonus structure.
But that's not based on productivity alone. In
fact, it's a five part,
element that's provides some objectivity
that I have our division leaders do, and
then I provide additional,
input that's on
teaching,
academics and research,
quality or service,
and, actually, citizenship.
Are you a good partner? Do you work
well together? And then productivity is the last
piece.
It's not that that we don't,
value productivity. I don't wanna make sure that
message Right. Gets out there. But,
but all these other things are important.
And and so we give objective criteria, and
all of our docs know that.
Absolutely.
Well, I think the biggest question, right, for
anyone listening
is is this model replicable. Right? So is
it replicable for other service lines, specialties, other
health systems, you know, who might be
in a more resource constrained environment.
What would
any of our listeners need to be true
in their organizations for this type of model
to succeed?
So that's
a very good question. A little difficult one,
but very good because,
you know, making sure that it's reproducible.
I would say it is, and I'll give
you example.
So when we
started this
effort,
this was implemented first at our
main
campus
hospital in Morgantown, West Virginia. And that started
in 2017,
you know, just a few months after
we opened the doors of the, Heart and
Vascular Institute.
But
it started there, but then we extended it
to all of our expansion sites.
So when we started in 02/1617,
we had essentially two to three,
satellite hospitals.
We now have 32
clinical sites. We have 25 hospitals.
We have nine key hospitals that do complex
cardiac care. And at each of our sites,
we make a very concerted effort of hiring
into the service line.
So into the departmental and academic structure even
though they work in the periphery.
So you mentioned resource constrained environments.
And so I'm not sure a 100% I
know exactly what you mean by that, but
I do know that we have many resource
constrained environments.
And and, like, that's where the caveat comes
in.
So, for example, in our more remote facilities,
which some of your listeners and, our colleagues
through Becker's,
they have very different,
geographic
areas. They have different practice models. They have,
different resources. And so in some of our,
very valuable but peripheral sites,
they are resource constrained. Our physicians need to
do more with less. They have less physician
coverage sometimes. They have less support staff, at
least initially, until their volume grows, particularly as
we expand.
And many times, they don't have resident
physicians or fellows.
And so to be fair to them,
while we did we do provide a,
good, if not elevated salary,
we did instate
a productivity
bonus incentive.
Not so not so that the structures are
at the
the the the,
salaries and the packages are at risk. In
other words, they have a very small base
comp and a high at risk, level,
but based on some RVU thresholds. So this
is when you get at at the really
and you hit your max RVUs. If you're
working really hard, we don't want to deincentivize
that work, particularly
when they're resource constrained, if that makes sense.
And so Mhmm. By doing that,
it it helps with the rurality
of our health system as well.
And and I think that's part of the
ability that we we partner very closely
with the CEOs at each of our system
hospitals
and respect that they
their their system hospitals, they work
each to their own bottom line. And so
part of our job as a service line
is to make sure that they're profitable,
and ensure that we drive volume to those
sites. And we can do that if you
have a,
more holistic,
evaluation of,
how referrals
come and go and,
making sure that we target
the patients to the,
level of the sites. Not to say that
in a pejorative way, but some sites are
not gonna be doing complex advanced
interventional therapies.
But they can all do certain
fundamental
levels, and not everybody has to come
to the mother ship, if you will. In
fact, part of our key mission
is that we provide
the best care closest to home. And by
eliminating that RVU element, it allows that to
be sustainable,
to that mission.
Perfect. Yeah. I I would encourage, you know,
all of our listeners, if they aren't aware,
just,
I feel like WVU
Medicine really does have a unique,
opportunity to represent
kind of
the rural and urban, and the demographic population
that you serve is
so, unique and and different maybe than, you
know, a stand alone center in New York
City or LA. You know? So,
I think the the example you gave really
does show how this model is replicable
for,
you know, other sites,
whatever,
rural or urban, like we said, but also,
maybe it's not one size fits all. Right?
So so another organization doesn't have to do
it exactly how you are doing it.
They can make it work for for what
they have. Would that be accurate?
Yeah. I would say I would say representative.
I think, what we do what we do
here at WVU Medicine, I think we are
representative
to
essentially the nation and all of our different
hospitals and different structures of hospitals because we
have the full spectrum of those hospitals,
and we try to keep those principles the
same.
But the other thing that helps us do
this is that
we,
we keep the corporate,
expense levels,
at a very fixed rate. So as we
grow, that
amount of
money going back to the mother ship, from
a corporate side
stays flat. We allow that
that that extra revenue to stay in our
partner hospitals so that they can reinvest in
their community.
So, again, that's part of the structure. That's
the vision of Albert Wright, our CEO,
to ensure that we
we say we we stay true to our
mission
and our word to the hospital so that
they grow. If they're successful,
the whole system is successful.
And so, yes, we have we do complex
the most complex thing that every other urban,
city, particularly in New York, you mentioned.
We do everything that that they're doing at
all these slice places, transplant,
LVADs,
etcetera.
But we also serve the,
the rural element,
which there's not
completely rural,
but they're in locations, including critical access hospitals
that are representative in many of others the
sites of in our union and particularly in
the Mid To Central United States.
Absolutely.
And I appreciate you bringing up that,
key piece to, I think it's, you know,
a key important reminder for for success.
Well, as we're wrapping up here,
really quickly, if there's one piece of advice
that you give could give to any listener
before they get started on a similar transition,
what would it be? I
would say
structure, number one, to make sure that you
have structure,
buy in, and
stakeholder,
support because
you really, really it has to start at
that administration or administrative level
that if you're a manager or a practice
manager and trying to push this through,
that might you might,
hit some headwinds.
You really wanna make sure that you you
get that holistic buy in. And and when
we look at this in the aggregate,
it allows for
super performing and slightly underperforming
groups
to still be successful.
It's not it's sort of a little bit
of the Robinhood,
you know, taking from those that are super
successful and helping support the those that are
not. And I say success successful
based on pure financial performance.
Not that they're not successful clinically because they're
super valued clinically.
But being able to do that in both
the PB and HP blend,
that is really the success,
and you need to have that
buy in and stakeholder,
support to be able to do that holistically
and not hit the headwinds as you're starting
to implement. So it starts at the beginning.
Perfect. Well, thank you so much for joining
me on the podcast today, doctor Burdoir.
It's a distinct pleasure to be with you,
Elizabeth.
Yes. This has been an amazing and informative
discussion. Thank you again for sharing your time
and your insights today.
I invite our listeners to tune into more
podcasts from Becker's Healthcare by visiting our podcast
page at beckershospitalreview.com.
Thank you again, doctor Boudoir, and I hope
you all have a wonderful rest of your
day.