Physician compensation structures have mirrored healthcare insurance, reimbursement and payment designs during the past decade, and are complex, variably interpreted and difficult to unpack. The results are highly variable compensation structures, often not firmly based on reliable data or well defined quality, safety and efficiency measures. In addition there is a large difference between the lowest and highest earning Physicians. In our health system, this difference is 4X for employed Physicians, and as much as 10X for independent Physicians.
In order to address some of these issues our health system (18 Hospitals in both urban and rural settings) is undertaking a comprehensive redesign of Physician compensation. The current task force approach is to reduce complexity, increase reliability of metrics, drive equity and align incentives. Initial focus will be on the employed Physician group, followed by PSAs (Professional Services Agreements; comprehensive contracts with independent Physician groups), and finally influence peddling with other Physician contracts.
We have looked at single payor systems in Europe for Primary Care and Specialty payment designs, as well as metrics for individual assessment of performance. Large Physician owned multispecialty groups in the U.S. have excellent, but often overly complex KPI metrics. Health insurance companies have lots of data, but are unwilling to share much that is meaningful. Most elusive is how to reduce compensation inequity, as this necessarily involves increasing pay for low earners, and decreasing income for high earners.
Anyone else out there grappling with these issues? (I know from another post that some group is at least tackling salary versus incentive compensation and the resulting motivational differences)
- Reduce complexity?
- Use reliable measures/data –> a real source of truth?
- Improve compensation equity?
- Allow for some individual choice?