Even if HCFA chooses not to make the compensation requirements for academic physicians consistent with those of other bona fide employees, it is imperative that the final regulatory language makes clear that productivity bonuses for AMC physicians are not prohibited. It is unreasonable to force AMCs to rely solely on preamble language to support the use of productivity bonuses. Such bonuses should be permitted, provided that the methodology for determining them is set in advance and the amount of the payment is at fair market value. HCFA also should ensure that what is allowed elsewhere in the rule regarding productivity bonuses apply equally to academic physicians. It is unclear why the both the preamble and rule discuss compensation paid for the previous period.
Compensation generally is set for an upcoming period of time.
It is not appropriate or reasonable to require a prospective determination of the compensation amount when this amount is determined by a fixed methodology. The AAMC also asks HCFA to recognize that the total compensation may be paid by different components of the AMC and each component may use different methodologies to determine compensation. This should be acceptable so long as each methodology is fixed for a specified period of time. Fair market value. The preamble to the regulation discusses the meaning of fair market value in an academic medical center.