Vinay Badhwar, MD, FACS, FACC, Executive Chair of the WVU Heart & Vascular Institute & Gordon F. Murray, Chair of the Department of Cardiovascular & Thoracic Surgery at West Virginia University School of Medicine

Summary

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Episode Summary: Becker’s Healthcare Podcast

Guest: Dr. Vinay Badhwar, Executive Chair, WVU Heart & Vascular Institute & Gordon F. Murray Chair, Department of Cardiovascular & Thoracic Surgery, West Virginia University

Host: Elizabeth Gregerson

Release Date: October 29, 2025

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Episode Overview

This episode features an interview with Dr. Vinay Badhwar, who leads WVU Medicine’s Heart & Vascular Institute. The discussion centers on the institute’s dramatic growth—moving from $225 million to $2 billion in revenue—after abandoning the traditional RVU-based compensation model for physicians. Dr. Badhwar outlines how this transition enabled innovation, improved quality of care, and increased physician satisfaction, while still meeting financial and productivity goals. The episode provides actionable insights for healthcare leaders nationwide, especially those interested in value-based, physician-centric care models.

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Key Discussion Points & Insights

1. Background and Unique Service Line Model

• [01:22] Dr. Badhwar introduces himself and the service line’s unique, blended structure:
  • Physician-based focus rather than hospital-based (HB) only.
  • The WVU Heart and Vascular Institute (HVI) oversees both physician-based (PB) and hospital-based (HB) components for integrated operations.

2. Transition Away from RVUs: Structural Pillars of Success

• [02:42] The RVU model shift relied on three main pillars:
  1. Integrated Structure: The ability to hire and collaborate across PB and HB, supported by system-wide oversight.
  2. Trust and Tight Collaboration: Strong alignment between institutional leaders (CEO, vice president, board) and vision.
  3. Comprehensive Buy-in: Engaging all leadership and physicians for shared commitment.
• Communication and data flow were essential—faculty are “empowered to have the freedom, but also the focus on evidence-based care.”
  • Administrative teams monitor RVUs and financials but shield physicians from direct RVU pressure, keeping focus on patient care and innovation.

3. Clinical Excellence, Innovation, and Growth

• [06:03] Under this model, the Institute has achieved:
  • 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.
  • Nearly 450,000 patient visits in 2024.
• Successful outcomes and high performance continue without direct RVU incentives.
• The model enables:
  • Accounting for rural/urban provider differences (e.g., “windshield time,” telemedicine).
  • Valuing non-RVU producing yet critical roles (e.g., outpatient cardiologists in rural settings).

4. Operational Insights: Data and Technology

• [07:01] Real-time interoperability and performance tracking are achieved using EPIC, providing unified clinical and financial data.
  • This supports integration, resource planning, and allows physicians to focus on research, trials, and innovation.

5. Compensation Model: Balanced and Holistic

• [09:48] Key to the success: Hire physicians dedicated to quality and teamwork, not just productivity.
  • Salaries at or above market rate to remove productivity pressure.
  • Bonuses are based on a five-part formula:
    1. Teaching
    2. Academics and research
    3. Quality or service
    4. Citizenship (teamwork)
    5. Productivity (RVUs are considered, but not prioritized)

6. Replicability and Adaptation for Other Systems

• [12:08 & 12:34] Is it replicable?
  • Yes, with caveats. Requires adaptation to specific environments (urban, rural, resource-constrained).
  • “Part of our job as a service line is to make sure [partner hospitals] are profitable and ensure that we drive volume to those sites. … Not everybody has to come to the mothership.”
  • In lower-resourced sites, a hybrid model is possible: base salary with productivity bonuses for those who exceed RVU targets, especially in constrained settings.

7. Holistic Success, Local Investment, and Mission Alignment

• [17:41 & 19:25] The institute operates with fixed corporate expense rates—as the system grows, more revenue stays local for reinvestment in community care.
• Emphasis on providing “the best care closest to home.”
• The integrated model supports both complex urban care and broad rural needs.

8. Advice for Other Organizations

• [19:48]

  “Structure number one, to make sure that you have structure, buy-in and stakeholder support… it has to start at that senior administrative level… When we look at this in the aggregate, it allows for super performing and slightly underperforming groups to still be successful. … Being able to do that in both the PB and HB blend, that is really the success.”
  – Dr. Vinay Badhwar [19:48]

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Notable Quotes & Memorable Moments

• On Culture and Trust:

  “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 … the simplicity of the model works.”
  – Dr. Vinay Badhwar [09:59]

• On Scaling and Adaptation:

  “What we do here at WVU Medicine… is representative to essentially the nation and all of our different hospitals and different structures… but… it’s not one size fits all.”
  – Dr. Vinay Badhwar [17:41]

• On Rural/Urban Integration:

  “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.”
  – Dr. Vinay Badhwar [15:52]

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Timestamps for Key Segments

• 00:00–01:22: Host introduction and Dr. Badhwar’s background
• 02:42–06:03: The three pillars of shifting away from RVUs
• 06:03–09:48: Innovations, growth, and the practical benefits of the new model
• 09:48–12:08: Compensation philosophy and alignment to quality, teaching, and teamwork
• 12:08–17:41: Replicability, rural/urban adaptability, and hybrid approaches in resource-constrained sites
• 17:41–19:25: Value of fixed corporate costs and revenue retention for local growth
• 19:48–21:05: Final advice for other organizations

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Key Takeaways

• Abandoning a pure RVU model, when coupled with integrated structure, trust, data, and leadership buy-in, can drive quality, innovation, and sustainable growth.
• The WVU model supports both highest-level academic medicine and broad community access, with adaptability for diverse hospital types.
• A holistic approach to compensation—valuing teaching, quality, teamwork, and research—creates a culture of sustained excellence beyond productivity metrics.
• Success depends on strong initial structures, system-level support, and tailoring approaches to each local site’s unique environment.

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Transcript

[A]

Welcome to the Beckers Healthcare Podcast. I'm Elizabeth Gregerson, a reporter here at Beckers, and I'm thrilled to interview Dr. Vinay Vidhwar, executive chair of the WVU Heart and Vascular Institute and service line at WV Medicine, and Professor and Chairman of the Department of Cardiovascular and Thoracic Surgery at West Virginia University. Dr. Bidwar, 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 million to 2 billion by ditching RVUs. And I think it's, you know, a conversation and insight that readers of any specialty 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.

[B]

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.

[A]

Absolutely. Before I hop into my questions, could you just give a brief introduction of yourself and where you're coming from?

[B]

Of course. Sure. So my name is Vinay Badwar. I'm 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 which 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 proceed here in this. This conversation.

[A]

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 how did you make it work?

[B]

Well, that's a great question. 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 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 an 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 and the School of medicine. Starting with that collaboration, I think is really critical because we align in our thoughts and visions of how the service line should work and function. But 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 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. 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 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 way of communicating back and forth 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 continued to maintain.

[A]

Perfect, thank you. 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 RVUs 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.

[B]

Well, that's very insightful. I appreciate your recognition of our team's development. You know, it's, we're having a good time by doing that. Remember, 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 what do I mean by that? That. Let's, let's be honest. 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 this portion of the health system. And we have, 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 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, our medical as well 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, but we're also a top enroller in many clinical trials. Sometimes that's a lot of effort that takes to work on clinical trials and being able to bring that to our population. And that takes time. And allowing our docs to have the time to do that I think is an important flywheel of success, if you will.

[A]

Absolutely. So kind of shifting to that value based care model has freed up and kind of opened up the opportunity for more growth and more innovation.

[B]

Absolutely right. 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 non clinical 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 going to contribute 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 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 we don't value productivity. I don't want to make sure that message gets out there, but all these other things are important. And so we give objective criteria and all of our docs know that.

[A]

Absolutely. Well, I think the biggest question right for anyone listening is is this model replicable?

[B]

Right.

[A]

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?

[B]

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 Vascular Institute. But it started there, but then we extended it to all of our expansion sites. So when we started in 2016 and 17, 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 100% I know exactly what you mean by that, but I do know that we have many resource constrained environments. And that's where the caveat comes in. So for example, in our more remote facilities, which some of your listeners and our colleagues through Beckers, 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 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 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 the really, 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 by doing that, it helps with the rurality of our health system as well. And I think that's part of the ability that we partner very closely with the CEOs at each of our system hospitals and respect that 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 going to be doing complex advanced interventional therapies, but they can all do certain fundamental levels. And not everybody has to come to the mothership, 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.

[A]

Yeah, 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 different maybe than, you know, a standalone center in New York City or la. So I think the example you gave really does show how this model is replicable for other sites, whatever, rural or urban, like we said. But also maybe it's not one size fits all, so another organization doesn't have to do it exactly how you are doing it. They can make it work for what they have. Would that be accurate?

[B]

Yeah, I would say representative. I think 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 mothership from a corporate side stays flat. We allow 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 and that's the vision of Albert Wright, our CEO, to ensure that 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. 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 they're doing at all these places, transplant, LVADs, et cetera. But we also serve the rural element, which there's not completely rural, but they're in locations including critical access hospitals that are representative in many of other sites in our union and particularly in the mid to central United States.

[A]

Absolutely. And I appreciate you bringing up that key piece too. I think it's a key, important reminder for success. As we're wrapping up here really quickly. If there's one piece of advice that you could give to any listener before they get started on a similar transition, what would it be?

[B]

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 senior 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 want to 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 Robin Hood, 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 HB 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.

[A]

Well, thank you so much for joining me on the podcast today, Dr. Badouar.

[B]

It's a distinct pleasure to be with you. Elizabeth.

[A]

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 [e-mail] thank you again, Dr. Bedwar, and I hope you all have a wonderful rest of your day.

[B]

Sam.