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PubMed2004

The alignment and blending of payment incentives within physician organizations.

OBJECTIVE: To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. DATA SOURCES: Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. STUDY DESIGN: We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. PRINCIPAL FINDINGS: Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. CONCLUSIONS: Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization.

Capitation Fee↗

PubMed1999

Financial incentives influencing the integration of mental health care and primary care.

Psychiatric problems are common in general medical practice and strongly influence utilization of medical care. Although several studies have demonstrated the positive clinical and financial impact of psychiatric interventions for medical patients, historic and economic forces have tended to maintain the separation of the primary health and mental health components of care. The author discusses the financial incentives that influence the success or failure of initiatives to integrate mental health care and primary care. Most models for financing care that use fee-for-service, carve-out, or capitated arrangements have done little to encourage collaborative treatment planning and coordination of care or have created conditions that work against such integration. True financial incentives for integration of psychiatric and primary health care are provided only by a shared-risk model of capitation-a model that has long existed in staff-model health maintenance organizations. This model increases motivation to lower overall utilization of care, improve patients' overall health status, and search for more effective models of care.

Capitation Fee↗

PubMed1997

Using quality and cost for employee incentives in a reengineered hospital setting.

The Mount Sinai Hospital is reengineering its inpatient services to increase the quality of patient care and achieve greater operational efficiency. The central component of this redesign has been the establishment of "care centers," which are administratively and fiscally separate "hospitals within the hospital." To promote quality and financial goals set for each care center, a novel employee incentive compensation program was created. Performance on both quality and financial indicators determines the level of bonus payments to hourly employees. The incentive compensation plan was initiated in the first quarter of 1996. By achieving two of the three performance targets, employees earned a bonus of 6% of base salary for the first two quarters. Nurses and pharmacists did not accept bonus payments because of collective bargaining agreements. The early experience of the Cardiac Care Center has been highly favorable. Changes are planned to improve the process further.

Academic Medical Centers↗

PubMedDate not supplied

Will financial incentives stimulate quality improvement? Reactions from frontline physicians.

Pay-for-performance is being applied at the physician level to stimulate improvements in quality of care and cost efficiency; however, little is known about how physicians will respond. We interviewed physicians exposed to a financial incentive program in California to identify possible barriers to the successful application of financial incentives by exploring physicians' opinions of and experiences with pay-for-performance programs. Reasons physicians cited for quality deficiencies included insurance coverage limitations and lack of patient compliance, time, and proper physician oversight. Physicians believe that they play a significant role and have a moderate to high degree of control over quality of care and that it is important to self-monitor. Physicians expressed the need for accurate and timely data, peer comparisons, and more patient time, staff support, and consultations with colleagues to successfully monitor and deliver quality care. Many support increased pay for delivering high-quality care but question measurement accuracy, bonus payment financing, and health plan involvement.

Adult↗

PubMed1990

Non-salary retention incentives for social workers in public mental health.

While workers' reasons for leaving jobs are myriad, little is known of what might induce workers to remain in jobs. The literature reports that money, alone, is not sufficiently persuasive as an incentive. This study of social workers in the public mental health system in Colorado reveals the incentive value of a set of non-salary retention measures. The findings of the study show that measures which furthered professional enrichment, contribution to the profession, and the exercise of professional autonomy are rated most highly. Cross-tabulations with some demographic variables reveal significant findings. Recommendations for implementing the findings are presented.

Colorado↗

PubMedDate not supplied

Realigning incentives in fee-for-service Medicare.

This paper proposes Medicare payment reform built on the fee-for-service system, with incentive payments to eligible provider organizations determined by their rate of increase in cost per patient compared to the overall growth rate in the community. By planning and monitoring how care patterns are altered to achieve greater efficiency, policy-makers can align the incentives of Medicare and the provider organization better than using either fee-for-service or capitation alone. This reform, unlike capitation, maintains Medicare's historical role as insurer and focuses providers on managing care.

Aged↗

PubMed1994

Long-run migration incentives and migration effects: the case of different fertility rates.

"In this paper the direction of the long-run migration incentive in the presence of closed borders and the long-run welfare effects of a regime change from 'autarky' to 'free permanent migration' are studied. A difference in birth-country specific fertility rates is treated as the final cause for the creation of migration incentives in a two-country model where the standard overlapping-generations framework is used.... Opening the borders for permanent migration can always lead to the equalization of labour force growth rates. A continuum of such equilibria with migration does exist, but the application of the concept of migration-stability, introduced in this paper, gives reason to the suspicion that free migration can also lead to a collapse of the emigration country's economy." (SUMMARY IN GER)

Demography↗

PubMed2002

National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

OBJECTIVES: Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. METHODS: Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. RESULTS: After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). CONCLUSION: Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

Adult↗

PubMed2004

Healthcare payment incentives: a comparative analysis of reforms in Taiwan, South Korea and China.

Payment incentives to both consumers and providers have significant consequences for the equity and efficiency of a healthcare system, and have recently come to the fore in health policy reforms. This review first discusses the economic rationale for the apparent international convergence toward payment systems with mixed demand- and supply-side cost sharing. The recent payment reforms undertaken in Taiwan, South Korea and China are then summarised. Available evidence clearly indicates that payment incentives matter, and, in particular, that supply-side cost sharing can improve efficiency without undermining equity. Further study and monitoring of health service quality and risk selection is warranted.

China↗

PubMedDate not supplied

The cardiovascular health impact of an incentive worksite health promotion program.

PURPOSE: We examined the cardiovascular health profiles of benefit-eligible hospital employees who participated in an incentive screen program for 4 years. We also determined if cardiovascular health changes differed between participants (CHAP) who enrolled in structured follow-up risk reduction programs (CHAPplus) compared with those who chose less formal options (CHAPonly). METHODS: CHAP consisted of cardiovascular screens, results counseling, and encouragement to participate in education and behavioral support programs. After adjusting for gender, medication use, and baseline levels of adiposity and physical activity, cardiovascular health changes were tested with repeated-measures analysis of covariance (ANCOVA) among CHAP participants and by CHAP type. RESULTS: CHAP 4-year members (n = 278) were generally healthy and mostly women (87%) with an average age of 40.6 +/- .5 years at baseline. Despite increases in overall (p = .034) and central adiposity (p = .001), cardiovascular health improvements were found for the total cholesterol/high-density lipoprotein ratio (TCHOL/HDL; p = .007), low-density lipoprotein (p = .009), and blood glucose (p = .018) among 4-year CHAP members. CHAPonly employees showed greater improvements in most cardiovascular health indicators than CHAPplus participants, although these differences did not achieve statistical significance. DISCUSSION: Cardiovascular health improvements were associated with long-term participation in a hospital worksite incentive screen program. The cardiovascular health benefits tended to be greatest for CHAP employees who chose informal follow-up risk reduction options (CHAPonly) than those who enrolled in structured programs (CHAPplus).

Adult↗

PubMed2002

A novel incentive system for faculty in an academic medical center.

The need to contain health care costs has led some physicians to become salaried employees of health care organizations. However, the use of nonfinancial incentives for physicians in such an environment has not been broadly explored. The authors describe a novel incentive system that is designed to promote continuing high-quality care and to increase patient access to health care while enhancing clinical and academic productivity and physician satisfaction. Key components of this system include annual targets, flexibility in meeting these targets, and ability to convert clinical productivity generated in excess of what was necessary to meet the target to support scholarly activities. This system led to increased faculty productivity, improved patient access, enhanced scholarly activity, and overall enhanced career satisfaction.

Academic Medical Centers↗

PubMed1991

An incentive plan for nurses: linking bonuses to both care and documentation.

Productivity and quality are not mutually exclusive as many nurses believe. Management's responsibility to its staff is to provide systems that will allow for safe and realistic productivity expectations while not compromising quality care. Incentives add to the program, but they are the last step in a series of changes that must be jointly agreed on before nurses can be financially rewarded. This program, which combines salary plus incentive for those nurses wishing to participate, is the end result of much effort, cooperation, and negotiation between nursing staff and management.

Community Health Nursing↗

PubMed1992

New rules on physician incentives.

The Office of Inspector General recently issued a Special Fraud Alert listing physician incentives it might consider "suspect." How should hospitals conform their incentive programs to the ruling?

Fraud↗

PubMed1995

Hermann agreement updates IRS guidelines for incentives.

The October 1994 agreement between the Internal Revenue Service (IRS) and Hermann Hospital of Houston, Texas, elucidates current IRS policy on physician recruitment incentives. The IRS distinguishes between the recruiting and the retention of physicians and perimts incentives beyond reasonable compensation in the former but not the latter circumstance. This new agreement, while not legally precedential, nevertheless provides guidance for healthcare organizations seeking safe harbor protection.

Guidelines as Topic↗

PubMed1997

Transition to capitation. Aligning incentives for success.

Horror stories abound about providers that have failed to modify their incentive systems and have exhausted their annual capitation budget in the first six months of the plan year. Aligning the business strategy and financial incentives in advance is the best way to ensure that your integrated delivery system's transition to capitation is a success story. Rarely are physicians or hospitals with experience limited to the fee-for-service arena prepared to jump into a managed care or capitated compensation system. The transition can be eased by implementing a "shadow" capitation or similar arrangement that will test physician performance under a risk arrangement in advance. The information can be used to restructure the compensation system to ensure that the behaviors being encouraged will promote successful care and fiscal management.

Capitation Fee↗

PubMed1997

Health care organization and incentives under emerging models of elderly health care.

Health providers are rapidly establishing integrated delivery systems to prepare for managed care and capitation. However, acute and primary services for the elderly continue to be reimbursed through DRGs or fee-for-service (FFS) payments. Different incentives and care patterns are described for providers caring for elderly populations and younger, capitated groups. Pilot programs to provide Medicare services to the elderly may become models or foundations for a future, capitated health system for the elderly. Existing models of elderly health care that receive capitated payments are described in this article, including Social HMOs, TEFRA HMOs. and PACE programs. The potential significance of these programs for the synchrony of operational incentives, comprehensiveness of health care, volume of institutional services, and primary care orientation is analyzed.

Aged↗

PubMed1989

An incentive pay program for radiology transcriptionists.

Incentive pay programs have been used by medical record departments for several years. This article describes an incentive pay program that has been designed for radiology transcriptionists. Benefits of the program include increased employee productivity and decreased report turnaround time. The program financially rewards the most productive transcriptionists and aids in employee retention.

Documentation↗

PubMed1979

Medicare and Medicaid physician payment incentives.

The incentives in the Medicare and Medicaid physician payment systems and their effects on six interrelated aspects of health care costs and beneficiary access to care were analyzed. Research results and data presented indicate that Medicare and Medicaid physician payment incentives are inconsistent with current public policy goals of (1) containing inflation in fees and expenditures, (2) encouraging physician participation in public programs, (3) improving the geographic and specialty distributions of physicians, (4) encouraging primary care instead of surgery, and also outpatient rather than inpatient treatment.

Ambulatory Care↗