Is Your Bonus Attainable or Just a Tease?

Leigh Page

Disclosures

November 17, 2016

In This Article

Tiers and Ladders Makes Bonuses More Attainable

Often, an organization adopts all three of the usual nonproductivity measures and scores doctors separately on each of them. So even if you do poorly on patient satisfaction, you could make up for it on the citizenship or process measure, and you would be likely to get some bonus payment.

Your chances of getting a portion of the bonus are further enhanced by providing several levels of achievement, or ladders, for each measure, Dr Knoll says. Whereas you might get 100% of the citizenship bonus if you attend more than 70% of your assigned meetings, you might still be entitled to one half of the bonus if you attend only 50%-70% of them, he says.

About 18% of employed physicians said they have bonus ladders, according to Medscape's Employed Doctors Report.[1] In comparison, 37% said they were paid a base salary plus productivity.

Providing a lot of tiers and ladders addresses the two chief goals of bonus programs: The high threshold pushes physicians further along than a lower threshold would do, and the lower threshold keeps lower-performing physicians in the game, which is crucial for any incentive program.

"The whole point of having an incentive is to nudge physicians toward a goal that the employer wants them to meet," Mertz says. If the bonus isn't seen as attainable, he says, many physicians will stop caring about it and it will lose its effectiveness.

For a bonus to be effective, Mertz says, its threshold should start low and rise as physicians get more proficient at meeting it. "If you want your doctors to run a marathon, you start them on a 5K run and allow them to work their way up."

Mertz says some employers can raise bonus thresholds without renegotiating the contract. This is done by putting the thresholds in an addendum to the contract, which the hospital can then update unilaterally, he explains.

Attorney Dennis Hursh says he has seen employers raise the threshold on employee productivity in some recent contracts he has reviewed. For example, now he comes across "pure productivity" compensation models, in which both the base pay and the bonus are governed by wRVUs. The base pay may be set at the median wRVU, and physicians who don't meet that threshold will see their base pay lowered in the following year.

Meanwhile, the bonus has been raised to the 75th percentile or higher. "This high threshold for the bonus is becoming more common at hospitals and health systems," Hursh says.

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