Hospitals and physician groups across the country are beefing up merit pay for quality and patient satisfaction in their physician compensation plans. But Geisinger Health System is doing something radically different.
The 12-hospital system based in Danville, Pa., did away with physician bonuses altogether this summer and put all of its 1,600 employed doctors on a straight salary.
Geisinger also made the decision to pay each physician at or above the national average whether in primary care or a specialty. “We don't have below-average doctors so we don't pay anyone below average,” Geisinger CEO Dr. David Feinberg said.
That Geisinger would abandon a compensation model that previously paid physicians 80% straight salary and a potential 20% performance bonus runs counter to what's happening with many health systems and physician groups.
Most systems see the emergence of value-based reimbursement, encapsulated in legislation like the Medicare Access and CHIP Reauthorization Act, as requiring the rewarding or penalizing of physicians for performance on quality and patient satisfaction scores.
They are shifting their compensation plans to put more emphasis on attaining those types of benchmarks rather than the old ways of predominantly rewarding throughput.
For example, Crystal Run Healthcare, a 300-physician group based in the lower Hudson Valley community of Middletown, N.Y., today pegs up to 15% of total physician compensation to quality, cost and satisfaction measures, said Dr. Scott Hines, Crystal Run's chief quality officer and medical director.
That percentage is set to rise to 30% over the next three years because “more and more contracts are being tied to clinical quality and lower costs,” Hines said. He's seeing the same trend with both government and private payers.
The compensation model at the 1,200-physician Henry Ford Medical Group in Detroit is a little different but similarly aimed at elevating quality and patient satisfaction, said group CEO Dr. William Conway.
The group's primary-care physicians next year will get a greater portion of their compensation based on how many consumers choose them as their doctor than today's model, which is predominantly based on the volume of relative value units they perform. RVUs represent a Medicare formula for reimbursing physician services that blends the time it takes to perform a service with the skill level behind that care. A committee that includes the American Medical Association offers recommendations to the CMS which establishes the relative weights of physician RVUs.
While RVUs determine 66% of pay at Henry Ford today, it becomes a 50/50 split next year between RVUs and patient sign-ups, Conway said. That model also provides an incentive for physicians to perform well on quality and patient satisfaction since consumers will see physicians' work rated online and can base their selections accordingly, Conway said.