Is Your Bonus Attainable or Just a Tease?

Leigh Page

Disclosures

November 17, 2016

In This Article

Other Formulas Crop Up as Well

Some employers have been backing away from productivity models and adopting bonus formulas that mirror value-based reimbursements, which reward doctors for saving money and improving outcomes. Called "nonproductivity measures" or "quality measures," they're used in 32% of the bonus formulas stated in Merritt Hawkins' 2016 report.

These measures typically include three items: patient satisfaction; attending committee meetings, called "citizenship"; and process and outcome measures, such as those used in Medicare's Physician Quality Reporting System.

Dr Knoll says these new measures can also be set too high, sometimes because organizations are still unfamiliar with them and push too hard to improve quality.

For example, he says that bonuses for hospitalists may be based on process measures—for example, giving vaccines to prevent certain potentially serious conditions, such as pneumonia. The bonus threshold may be set at or near 100% utilization, which Dr Knoll says would be virtually impossible to meet, because a busy doctor may occasionally forget to write a prescription for the vaccine or the nurse may forget to administer it.

Such quality measures can be particularly unfair to the doctor when others are involved. For example, a doctor might get a low patient satisfaction score owing to a rude staff member or other clinician on the team. An administrator might argue that this relationship ought to motivate the whole team to "align their values," to use the rhetoric. But Dr Knoll says this expectation is "unreasonable, because you only have so much control over other people."

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