new incentive system

[jdumoch]

So the UC clinics I work for just started a new incentive system.. and it's unlike anything i've seen before. thought i'd post it and get some feedback. its based on 100 points, and can earn 5k per quarter. NOT rvu based which i find interesting. each metric has the potential to earn x amount of points, and % of the 5k is based on how many points you get. metrics include patient's per quarter (max > 1200), patient satisfaction, staff satisfaction, attendance at staff meetings, attendance at marketing functions (health fairs, etc), and a few other minor ones. very interesting, and seems pretty easy to hit the max.

[Gordon, PA-C]

So the UC clinics I work for just started a new incentive system.. and it's unlike anything i've seen before. thought i'd post it and get some feedback. its based on 100 points, and can earn 5k per quarter. NOT rvu based which i find interesting. each metric has the potential to earn x amount of points, and % of the 5k is based on how many points you get. metrics include patient's per quarter (max > 1200), patient satisfaction, staff satisfaction, attendance at staff meetings, attendance at marketing functions (health fairs, etc), and a few other minor ones. very interesting, and seems pretty easy to hit the max.

 

Incentive programs are trojan horses.... eventually the "bonus" will be switched into a "penalty" as in if you dont hit maximum scores they start docking your pay.

 

They sound good on the frontside, but I would hold judgment and see what happens 3 or 4 years down the line before you get too excited

[Guest JMPA]

totally agree, its like dangling candy in front of a child to persuade them, don't fall for that trash, insist on a fair salary and what your worth, rvus make sense but when talking about satisfaction surveys it becomes to subjective, and subjectivity gets manipulated

[bobuddy]

totally agree, its like dangling candy in front of a child to persuade them, don't fall for that trash, insist on a fair salary and what your worth, rvus make sense but when talking about satisfaction surveys it becomes to subjective, and subjectivity gets manipulated

 

Yep. Our clinic recently got the brilliant idea that they should have the patient's fill out satisfaction surveys for the providers. Whomever received the best survey results "wins a prize". Gag.

 

The problem with this kindergarten way of thinking is - a patient that comes in to my office may or may not leave happy. Maybe I didn't give them an antibiotic for their cold, or the narcotics, or maybe for the hundredth time I asked them to quit smoking, eat better, exercise more - whatever. My job is to not make them happy - it is to give them best medical care or advice that I can - whether or not they want to hear it. But according to our new clinic - these surveys will be incorporated to determine the amount of raise I get each year. Huh?

 

Here is another brilliant idea that our clinic came up with - to give each and every one of our patients (as they come in the door for height, weight, bp,etc ) a paper on their BMI and then document in their chart that they were given the forms. Guess what? I live and practice in Ky - 40% of my patients are either overweight or obese. Now, my nurse has made them mad even before I walk in the door. Nice. Then my nurse has to say -"Can you please fill out this form to tell us how satisfied you are with your visit today?"

 

In front of our new clinic managers (since we joined the conglomerate), I walked out of a exam room and threw all of those BMI papers into the shred box. I told my nurse to NEVER give my patients one of those forms again. And then told them " Just because your BMI is in the "normal range" does not mean you are healthy. You can be thin, sitting on the couch every day, eating cheetos and playing video games, but according to your stupid papers, they are doing just fine". NOT.

[ventana]

in theory, this is probably a great idea, in reality is so susceptible to manipulation. It will end up being used to keep money in the owners pockets. Good luck.

[EMEDPA]

The cost of pt satisfaction:

http://www.ncbi.nlm.nih.gov/pubmed/22331982

 

"satisfied" pts who receive whatever they want die faster!

can I have that antibiotic/narcotic/lab test I don't need/surgery I don't need ?

 

I have told this story before here. one of the docs in my group was put on probabtion for low pt satisfaction scores. to prove they were bs, he wrote percocet for everyone with pain for 1 year. the next year he was #1 on the pt satisfaction scores.

[jdumoch]

I think part of the reason I like this system, however, is that so little emphasis is on patient satisfaction. ER jobs i have held have always put >30% of bonus money on satisfaction, whereas this system only puts 10%. I like the idea of it because it encourages things like attending staff meetings, attending events to publicly advance the company... etc etc. I understand incentives can be dangerous, and I must say I am salaried more than I expected from an urgent care clinic, and actually make significantly more than previous ER jobs. the incentive is just something extra, not to count on, but to be a decent additional income when achieved. i thought this was one of the more benign systems i've seen... but i guess i'm in the minority.

[EMEDPA]

most bonus systems involve fuzzy math. my preference is straight salary at a higher rate.

my current bonus system pays bonuses out of profit so if the group buys a new toy or donates money to a hospital project or hires a new coder or whatever, bonuses go down. PAs have no say in these extra expenditures so my bonuses have ranged from $19,000 to $220 for the same time period with no change in how hard I am working.

I say split the difference and show me the money up front.

[physasst]

This is all part of the ACA reform under the value guidelines.

 

Changing how we pay for care....which is a good thing.

 

CMS has already implemented these changes, which is why you are seeing these bonus structures.

 

In the hospital, the VBP program (Value Based Purchasing) will use the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) to tie 30% of hospital reimbursements to the patient "experience of care".....

 

In the outpatient setting, the new CMS models for ACOs dictate that under a SSP (Shared Savings Plan), 7 of 33 measures will be directed at the "patient experience" and will determine reimbursements.

 

Keep in mind this is in the aggregrate. We will ALL have some unhappy patients. You will be measured against your peers, and your patients satisfaction WILL be tied to your reimbursement....

 

That's a good thing.

[EMEDPA]

Keep in mind this is in the aggregrate. We will ALL have some unhappy patients. You will be measured against your peers, and your patients satisfaction WILL be tied to your reimbursement....

.

unless they do it by shift night shift folks will get hosed.

when do most of the bogus back pain/dental pain pts show up? 10p-3am

what % do I give narcs to? 0%

how happy will they be?

[rcdavis]

unless they do it by shift night shift folks will get hosed.

when do most of the bogus back pain/dental pain pts show up? 10p-3am

what % do I give narcs to? 0%

how happy will they be?

 

Exactly. The thing is, as always, non practicing administrators or researchers ALWAYS design metrics that sound good, and have little to do with the good practice on one on one medicine

[G. Davenport]

Just give everyone what they want and your ratings will be high. Vicodin, sure. Oh sorry, did you say Vicodin 10. Percocet. Ok. OxyContin. Why not. Your cat ate them. Oh, let me write a new rx. Reality is, you should never be paid based on patient satisfaction unless your allowed to do a survey on the patient too.

[EMEDPA]

also they need to survey ADMITTED patients as well as those we d/c home.

who will be happier the uri who didn't get abx, the dental pain who didn't get narcs or the subtle PE you caught, admitted and saved their life?

[dhageremtp]

We are given $500 per quarter if our pt satisfaction is over 80%. I agree with above pt satisfaction does not mean the best medicine, often times its the opposite.

 

Our bonus system is a bit fuzzy too. We get a dollar multiplier times our RVUs over our target. Each year you make a bonus they increase your salary but also raise your target. We were told our raise is directly tied to our revenue generation, don't increase your revenue generation, no raise. It's crap!

[physasst]

You won't be measured on a patient by patient basis. You are measured in the aggregrate. You will also be compared to others within your specialty.

[EMEDPA]

You won't be measured on a patient by patient basis. You are measured in the aggregrate. You will also be compared to others within your specialty.

my point was nocturnists will have lower scores than the avg er providers who rotate all shifts because they see more folks who leave unsatifsfied.

[Guest Paula]

You won't be measured on a patient by patient basis. You are measured in the aggregrate. You will also be compared to others within your specialty.

 

When you say compared to others in your specialty do you mean others in the whole USA or just the "others" in your particular system? CMS will tie our reimbursement based on satisfaction scores? Huh? How will they know if my patients are satisfied? What if the billing ends up under the SP? How does this affect the little clinics with only 2-3 providers?

 

I'm on salary so don't know if it will change my pay. Unless our reimbursements fall dramatically because we don't meet meaningful use I don't think my employer will figure this all out before I retire in 10 years.

[physasst]

When you say compared to others in your specialty do you mean others in the whole USA or just the "others" in your particular system? CMS will tie our reimbursement based on satisfaction scores? Huh? How will they know if my patients are satisfied? What if the billing ends up under the SP? How does this affect the little clinics with only 2-3 providers?

 

I'm on salary so don't know if it will change my pay. Unless our reimbursements fall dramatically because we don't meet meaningful use I don't think my employer will figure this all out before I retire in 10 years.

 

CMS will be surveying all of your patients. This is already in motion and patients are already filling out and completing surveys (and have been for awhile) in order to establish benchmarks and ranges.

 

As far as I know, comparisons will be on a specialty specific, regional basis. IOW, you will be compared to other providers in your same region and specialty.