As the increasing focus on pay-for-performance threatens the traditional fee-for-service compensation model, hospitals and physicians wonder exactly how the compensation model will work. Ray Gyarmathy, MD, and Fred Jenkins, MD, from emergency medicine services provider Titan Emergency Group in Jacksonville, Fla., answer questions on how physicians are compensated for providing quality care and how hospitals can track that performance to get on board with healthcare's latest compensation trend.
Q: In a pay-for-performance compensation model, what practices can lead to increased compensation for physicians?
Dr. Ray Gyarmathy and Dr. Fred Jenkins: In general, [this kind of] compensation structure is designed to encourage high quality care, reduce patient's length of stay in the emergency department and improve overall productivity. We measure our [emergency medicine] doctors' individual performance toward meeting these goals by looking at specific metrics, including:
1. The number of patients seen and billable services provided per hour;
2. The accuracy and thoroughness of patient cards;
3. Compliance with hospitals' risk-reduction initiatives;
4. Patient satisfaction scores; and
5. JCAHO core measures.
Q: Similarly, what practices could lead to decreased compensation for physicians?
RG and FJ: Disincentives translate into fines for things like arriving late to a shift, missing a shift without prior notice, complaints from hospital staff and readmissions within 72 hours of discharge that result from inadequate care.
Q. How can hospitals or outside companies track physician performance in order to determine appropriate compensation?
RG and FJ: Titan uses a dashboard tracker to measure metric-based performance. To monitor physician performance that isn't metric based, such as feedback from hospital staff and community participation, we turn to our on-site medical directors. These individuals' primary responsibility is managing the emergency departments we serve. However, they also make sure our physicians remain productive and provide direction to enhance productivity.
Q. What percentage of your physicians' salaries is affected by their performance?
RG and FJ: Our physicians' salaries are 100 percent productivity-based. Each doctor has a base salary based on a minimum level of productivity. In other words, we expect a certain level of performance. Once a physician's productivity goes beyond that level, his or her efforts generate profits for the group. Their compensation increases via a bonus that reflects their contribution to that profit. This structure allows many of our physicians take home twice their base salary with a few earning even more.
Q. How do physicians, administrators and patients react to the pay for performance model?
RG and FJ: Our incentive model attracts a certain type of physician. The members of our tight-knit team are driven by a competitive spirit, tenacious in their efforts, and bolstered by well-founded confidence. They like the incentive model because it puts them in complete control of their financial future.
Administrators like it because it produces the results they want. All of the metrics we evaluate mirror the concerns of our hospital clients. If the doctors are performing well, the emergency department is running smoothly.
Likewise, patients benefit. While they're not aware of our doctors' compensation model, they're certainly aware of a faster, more comfortable and more streamlined process — all of which translates into higher satisfaction scores.
Read more about Titan Emergency Group (formerly Southeast Emergency Consultants).
Q: In a pay-for-performance compensation model, what practices can lead to increased compensation for physicians?
Dr. Ray Gyarmathy and Dr. Fred Jenkins: In general, [this kind of] compensation structure is designed to encourage high quality care, reduce patient's length of stay in the emergency department and improve overall productivity. We measure our [emergency medicine] doctors' individual performance toward meeting these goals by looking at specific metrics, including:
1. The number of patients seen and billable services provided per hour;
2. The accuracy and thoroughness of patient cards;
3. Compliance with hospitals' risk-reduction initiatives;
4. Patient satisfaction scores; and
5. JCAHO core measures.
Q: Similarly, what practices could lead to decreased compensation for physicians?
RG and FJ: Disincentives translate into fines for things like arriving late to a shift, missing a shift without prior notice, complaints from hospital staff and readmissions within 72 hours of discharge that result from inadequate care.
Q. How can hospitals or outside companies track physician performance in order to determine appropriate compensation?
RG and FJ: Titan uses a dashboard tracker to measure metric-based performance. To monitor physician performance that isn't metric based, such as feedback from hospital staff and community participation, we turn to our on-site medical directors. These individuals' primary responsibility is managing the emergency departments we serve. However, they also make sure our physicians remain productive and provide direction to enhance productivity.
Q. What percentage of your physicians' salaries is affected by their performance?
RG and FJ: Our physicians' salaries are 100 percent productivity-based. Each doctor has a base salary based on a minimum level of productivity. In other words, we expect a certain level of performance. Once a physician's productivity goes beyond that level, his or her efforts generate profits for the group. Their compensation increases via a bonus that reflects their contribution to that profit. This structure allows many of our physicians take home twice their base salary with a few earning even more.
Q. How do physicians, administrators and patients react to the pay for performance model?
RG and FJ: Our incentive model attracts a certain type of physician. The members of our tight-knit team are driven by a competitive spirit, tenacious in their efforts, and bolstered by well-founded confidence. They like the incentive model because it puts them in complete control of their financial future.
Administrators like it because it produces the results they want. All of the metrics we evaluate mirror the concerns of our hospital clients. If the doctors are performing well, the emergency department is running smoothly.
Likewise, patients benefit. While they're not aware of our doctors' compensation model, they're certainly aware of a faster, more comfortable and more streamlined process — all of which translates into higher satisfaction scores.
Read more about Titan Emergency Group (formerly Southeast Emergency Consultants).