Incentivizing Physicians for Quality Through Data, Compensation and Cultural Redefinition

Physicians play a critical role in quality improvement at hospitals and health systems. Incentivizing physicians to improve quality and help meet the organization's goals is essential to a hospital's and health system's success in enhancing performance.

Dr. Imran Andrabi issenior vice president and chief physician executive officer of Toledo, Ohio-based Mercy.Educate physicians that accountability for quality is happening now

First and foremost, incentivizing physicians to engage in quality improvement needs to begin with education and definition of the new reality. It's important for hospitals/health systems to make sure physicians are aware of the state of healthcare quality across the country and the new requirements for quality and patient safety, clinical documentation, billing, coding and reimbursement practices as well as the organization's quality-related goals so physicians can become part and parcel of these efforts. Fortunately, there are some physicians, as in any cohort, who truly understand and become champions of quality. There are others who feel they already do a quality job, have nothing else to learn and believe quality really is the health system's issue. Hospitals have to make sure physicians understand the healthcare industry's quality focus is here to stay in a very meaningful way and will change significantly how physicians will be paid and held accountable for their work. This is where we will move from volume of work done to value of the work product

One of the challenges is that there's been a lot of discussion and rhetoric about improving quality for a very long time, but it hasn't really impacted the physicians directly in a meaningful way until now. It is extremely important to make sure physicians understand that accountability for care in a high-quality, low-cost manner has finally become a reality.

Data analytics sparks competitive nature

Incentivizing physicians also requires hospitals and health systems provide dependable data analytics to physicians so they understand their work product better. Comparing data on their performance to their peers' performance is a great motivating force for physicians, because by nature they are very competitive and don't like to not be in the top tier of performance.

However, it's important that hospitals and health systems not only give physicians data once in a while in an ad-hoc manner, but ensure that there's a good feedback loop for giving them data as close to real time as possible. That data should be relevant and meaningful to the physicians and tie back to their goals and the goals of the system so that they may utilize the data to continuously improve their practice. For example, Mercy physicians can access data via a program called Crimson, which is part of the Advisory Board Company. Crimson provides a significant amount of quality process improvement, financial and clinical data to physicians.

Through this program, we're educating physicians and giving them access to their own data in real time. They don't have to be dependent on us to provide data, but can analyze their data themselves and learn from it. They can understand how they're performing relative to not only their own cohorts but also relative to their own specialty across hospitals in the database and relative to national benchmarks. This is a great learning tool that also generates questions and dialogue amongst physicians, between chiefs of staff and chairs of departments and the members of the departments. Crimson data is available in the ambulatory setting as well. This is just one example of the various tools out there that can do the same type of reporting for systems.

We've also just invested in another database called Explorys that is available in ambulatory practices. It downloads data from our electronic health record every 24 hours, so our physicians have access to their performance data relative to their group, to their specialty, to the cohort and national quality benchmarks.

We see the ability to compare performance data as a great incentive and motivating force for physicians to improve their performance.  

You can't improve what you can't measure and share with those who need to improve it.

Leadership positions and engagement motivate physicians

Another strategy to incentivize physicians is giving them leadership positions within quality to help engage them in dialogue, design, implementation, measurement, peer engagement and execution. Traditionally we have had physicians as chairs of a department, chiefs of staff and chief medical officers. That's great; but, I think physicians also need to move into a chief quality role, both in a formal and an informal leadership capacity

When physicians lead quality initiatives, the projects aren't looked upon as something the administration is telling physicians to do, rather as something physicians tackle with their peers. At Mercy, we have physician quality teams in the hospital and on the ambulatory side looking at quality and providing feedback. Developing teams of physicians that review data and give feedback helps significantly in moving the quality agenda forward. Physicians at Mercy are engaged in every aspect of quality, from governance to risk management to peer review to development of new quality initiatives that continuously make us the preferred place to practice and take care of patients.

Financial incentives can change behavior

Incentives can also be a motivator for physicians. We are using them particularly with those employed by us, by not only compensating for seeing patients, but for seeing patients and providing high-quality care with a superior care experience. Hospitals' compensation structures should have clearly defined quality metrics, which may be different in primary care compared with specialty practice. For example, in primary care there are specific quality metrics built into patient-centered medical homes that we have embarked on and will significantly impact the care and access provided to our patient. Additionally, the metrics will allow our physicians to practice at the top of their license and be partners in quality finance. On the specialty side, we are in the process of developing specific quality metrics by specialty that compensation will be tied to. Our goal is to ultimately have almost 30 percent of our physicians' compensation tied to quality and outcomes.

In addition, we need to make sure the quality metrics we're looking at are aligned with the overall quality goals of the organization and where healthcare is moving from a big picture perspective. We have a robust process where we set quality goals on a yearly basis throughout Catholic Health Partners as a system, and then they are cascaded out to each hospital through our board and the medical executive committees to make sure everybody understands the objectives and to align incentives to ensure the best outcomes. The same types of metrics are utilized in the ambulatory setting. As we move to ACOs, clinical integration quality will be measured not only with the component parts of the organization, but across the entire organization. In the era of ACOs and bundled payments, quality performance standards are a must-have.

Quality-focused culture

Whatever we do to incentivize physicians for quality, we need to do it with a long view in mind. We have to make sure we have the right culture and that through processes and structures we enable people to do the right thing the first time while making it difficult to do something wrong.

Successfully incentivizing physicians to improve quality ultimately depends on having a strong culture of quality. In healthcare, all people who deliver care become part of the quality team. Not only physicians, but nursing staff and ancillary staff embrace the fact that quality is our job; it's not just delegated to the quality department. Physicians are a piece of it — an important piece — but developing the structure, the mindsets, the focus and the culture is number one.

Imran Andrabi, MD, serves as senior vice president and chief physician executive officer of Toledo, Ohio-based Mercy, part of Catholic Health Partners. He previously served as president and CEO of Mercy St. Vincent Medical Center in Toledo. He is a diplomat of the American Board of Family Medicine and the American Board of Managed Care Medicine.

More Articles by Dr. Imran Andrabi:

Healthcare Reform After the Supreme Court: Where Do We Go Now
Furthering Our Missions: Physician Strategy as the Foundation to Improving Community Health

A Culture of Continuous Improvement is Necessary for Success Under Value-Based Care

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