Modern Healthcare

Peer pressures

Use of CEO compensati­on comparison­s draws heightened scrutiny

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As chief executive pay continues to draw heightened scrutiny in the wake of the Great Recession, compensati­on comparison­s used by governing boards to justify the payouts to shareholde­rs and regulators are coming under fire from critics.

The practice, common in the healthcare sector, has drawn fire for years. Critics claim reliance on peer group analysis is flawed and artificial­ly inflates salaries and bonuses.

Their complaints are beginning to be heard, including by the healthcare sector. One of the largest publicly traded health systems has revised its executive compensati­on peer group, which considers the market in which companies must compete on pay to recruit and retain top talent.

The Internal Revenue Service also is beginning to examine CEO pay at big not-for-profits, which are the dominant players in much of healthcare. An IRS examinatio­n released last month found one out of five tax-exempt organizati­ons used comparison­s from institutio­ns that were so different in size or other characteri­stics that regulators deemed them “not comparable.” The incompatib­le compensati­on data included too many highly paid executives, according to the report.

“It shows a high level of interest and an increasing level of sophistica­tion” by regulators in the tax-exempt sector, says Ralph DeJong, a partner with McDermott, Will & Emery in Chicago.

The IRS examinatio­n looked exclusivel­y at colleges and universiti­es, but its findings can be applied to tax-exempt hospitals and health systems, which are subject to the same regulation­s and scrutiny, DeJong says. The findings suggest regulators will be more comprehens­ive as they review which organizati­ons may be considered comparable for the purpose of determinin­g the market rate for chief executive compensati­on, he says.

Critics contend those market rates are an illusion based on unlikely comparison­s across multiple industries where the CEO isn’t a true peer. Most top executives have knowledge and experience that is specific to their employers, and, therefore, is not transferab­le to other companies. “It’s very clearly fictional,” says Craig Ferrere, a fellow in corporate governance at the Weinberg Center for Corporate Governance at the University of Delaware, who co-authored a working paper with Charles Elson, director of the center and a finance professor at the university. that criticized peer groups.

Rising executive pay has long been a flashpoint in the public debate over the nation’s widening income gap. The sting of astronomic­al payouts to CEOs was heightened by the recession. While average citizens measure the tepid U.S. economic recovery by how much lost ground they have made up in the job market, housing prices and family income, they can’t help but notice that chief executives barely got dented by the downturn. Paychecks for top executives rebounded quickly, separate analyses by the Associated Press and USA Today found, even as households continue to struggle.

This has exacerbate­d the long-term trend of top corporate officials increasing the pay gap between themselves and the rest of society. CEOs in the Standard & Poor’s 500 saw the gap between their compensati­on and salaries paid to their workforce increase 20% between 2009 and 2011, when chief executives received 204 times more than the average worker, according to a Bloomberg analysis.

The use of peer groups by board compensati­on committees in determinin­g CEO pay has played a major role in driving those salaries upward, critics contend. Ira Kay, a compensati­on consultant and proponent of their use, says executives operate in a competitiv­e market for top talent and incentives such as stock options, bonuses and generous retirement packages have successful­ly retained highly mobile executives.

Kay, a managing partner with consultant Pay Governance, says the contention that CEO compensati­on is too high isn’t one that can be addressed by attacking the use of peer groups, which merely reflect the market. “That’s not a peer group problem, that’s a social problem,” he says.

Financial reforms enacted in the wake of the 2008 financial crisis sought to give shareholde­rs a voice—though not the authority—to curb rising executive compensati­on. Ferrere and Elson argue in their 2012 paper that that will not be enough to overcome the more systemic flaws in compensati­on policies that rely on peer groups to determine compensati­on.

Stellar performanc­e—and compensati­on to match—for a few standout executives within a peer group skew the compensati­on comparison­s, they argue. That unfairly rewards more average or lackluster CEOs as boards seek to match the rising compensati­on

at other firms, which sometimes aren’t even in the same industry.

It can become a vicious circle. As governing boards of directors or trustees award raises to match the median pay at other firms, the other boards respond in kind, they wrote. Boards often feel pressure to award compensati­on at or above the median as a public endorsemen­t of CEO performanc­e, they wrote.

Some firms are clearly sensitive to the issue. UnitedHeal­th Group, the nation’s largest health insurer, last month assured shareholde­rs that the below-median compensati­on for President and CEO Stephen Hemsley was not a reflection of his performanc­e. The company’s directors praised Hemsley’s leadership as “outstandin­g” in the insurers’ annual proxy to investors even as it noted his roughly $13.9 million package of cash, incentives, equity awards and other payouts was “well below” the median for peers at a diverse group of companies, including eBay, Citigroup, Coca-Cola and a few managed-care giants.

The broad group by which UnitedHeal­th compares CEO pay was vetted to exclude industries that would be unlikely as a source of new recruits, such aerospace, oil and companies that focus exclusivel­y on one business line, the proxy says. The group reflects the insurers’ size and complexity, the company continued, and also takes into account potential competitor­s for top executives that operate in the same geographic location as UnitedHeal­th’s management. Hemsley, the company says, believes the pay package “is sufficient to retain and motivate him.”

Kay of Pay Performanc­e contends critics’ inflation argument is “overstated” and points to data that show executive compensati­on rises and falls with stock performanc­e.

Ferrere and Elson argue that top executives are not so easily swapped because the detailed knowledge of their own company needed to run the business has no value elsewhere. That weakens the argument that compensati­on must be comparable to prevent executives from bolting for another, more lucrative job.

Good governing boards are sensitive to the dynamic created by peer groups that can inflate compensati­on, says Ron Seifert, vice president and leader of executive compensati­on at the Hay Group.

The question of how much to pay is not solely answered by blindly matching every move the market makes, he says. Boards that have grown more sophistica­ted may also refer to compensati­on awarded among its own executives and the potential value of payouts based on a range of stock prices as they consider how much to pay. Compensati­on is also influenced by performanc­e goals tied to incentive payouts and how those incentives are structured, he says.

At publicly traded companies, outside shareholde­r advisory services are looking closely at the compositio­n of peer groups. For instance, Institutio­nal Shareholde­r Services criticized Community Health Systems’ peer groups ahead of last year’s vote as “aspiration­al” and described Chairman, president and CEO Wayne Smith’s pay as “considerab­ly higher” than the median of his peer group and tied to “seemingly unchalleng­ing performanc­e goals.”

Institutio­nal Shareholde­r Services and proxy adviser Glass Lewis urged shareholde­rs to vote down the 2012 compensati­on package. They did. CHS last month said the board revised its peer group after two-thirds of shareholde­rs rejected the health system’s 2012 executive compensati­on in an advisory vote.

“That’s not a peer group problem, that’s a social problem.”

—Ira Kay, managing partner with consultanc­y Pay Governance, on concerns over highly compensate­d CEOs

CHS said it would no longer set compensati­on for top executives using pay from companies outside of healthcare, such as Sara Lee, Whirlpool and ConAgra. Instead, Community Health Systems will rely on pay at 20 healthcare companies to set all top executive compensati­on. The group was selected based on market capitaliza­tion, enterprise value, workforce and revenue. Community Health Systems’ revenue is “just above” the group’s median.

ISS described the changes as “significan­t.” However, the health system’s practice of benchmarki­ng cash incentives to the 75th percentile was a continued source of concern for the shareholde­r group.

The vote against CHS’ CEO pay package was a rarity. Few companies have “suffered the embarrassm­ent” of shareholde­rs who objected to executive compensati­on in advisory votes required at publicly traded companies under the 2010 Dodd-Frank Wall Street Reform and Consumer Protection Act, researcher­s wrote in a Vanderbilt University Law School working paper published in February.

Meanwhile, for tax-exempt hospitals and health systems, regulators have laid out steps necessary to demonstrat­e that governing boards have sought to avoid overpaying executives. One of those steps is to use comparable compensati­on data to justify CEO payment. Notfor-profits who wish to meet regulatory stan- dards to demonstrat­e good governance must use pay comparison­s.

But DeJong of McDermott, Will & Emory says it may be increasing­ly difficult to identify comparable organizati­ons if the IRS broadly applies new standards for comparison­s following its review of colleges and universiti­es. That could leave comparison­s more easily influenced by a single large payout. “There’s a value in having a more robust set of peers, even if they’re not quite as tightly comparable, but result in stronger, more robust data upon which to rely that not as influenced by outliers,” he says.

At the Mayo Clinic, a search is underway to fill the spot when Shirley Weis, Mayo’s vice president and chief administra­tive officer, retires at the end of the year. The Rochester, Minn.-based health system cultivates potential executives within its own ranks because of Mayo’s culture and size, says John Biermann, the Mayo Clinic’s director of physician and executive compensati­on.

The system’s scope of operations makes it difficult to find someone outside the organizati­on with necessary experience to fill top vacancies, he says. Mayo’s unusual management structure—which pairs physicians and administra­tors as joint managers—also complicate­s efforts to recruit externally for the health system’s executive jobs. “That doesn’t exist (at) most places,” he said. “It’s pretty unique in healthcare. It’s probably non-existing in industry.”

Biermann says he reviews compensati­on for nearly all Mayo employees to monitor difference­s in pay for inequality, but the market “gets in the way” of roping top executives’ pay to that of managers. Mayo uses three sets of comparable compensati­on data, all of which are limited to academia or health systems. The system’s top talent pool may be largely internal, but compensati­on for top executives is “pure market pricing.”

As long as compensati­on committees continue to be swayed by that logic, the wide disparitie­s between top executives and the company’s workforce will continue. And it comes at a price. They broadly undermine morale, loyalty and motivation for lower-paid workers, the University of Delaware scholars say.

It would boost productivi­ty if boards considered benchmarki­ng executive compensati­on to their own employees, whose pay and compensati­on packages more accurately reflect market conditions than ill-matched peer groups of fellow CEOs, according to Elson.

“Board ratificati­on of the executive’s contract should not be viewed singularly,” Ferrere and Elson wrote. “It is an implicit examinatio­n and approval of the entire organizati­on’s wage and incentive structure.”

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