The hematology-oncology division of an academic health center participated in a pilot physician compensation exercise using variable compensation incentives with group-specific targets based on prior below-average performance.
Physician compensation models range from straight salary to complex structures involving pay elements that vary due to achievement of specific goals. Some models use work relative value units (wRVUs) and other models use variable compensation when greater efficiency and cost savings are achieved. Whatever the model, physician compensation is likely to be a continuing topic of debate regardless of current financing.
The 11-member hematology-oncology division of Baystate Medical Practices used the American Society of Clinical Oncology’s (ASCO) Quality Oncology Practice Initiative (QOPI) measures as targets for the group’s variable compensation. The compensation plan included base pay and incentive pay and was composed of five categories of performance based on individual/division activity and overall performance of the health system. Findings were published in the October issue of the Journal of Oncology Practice
The individual areas included: patient-centered goals, quality measures, clinical productivity, and academic targets. Grace Makari-Judson, MD, and colleagues write in the paper that 20% of overall variable compensation was linked to success in two QOPI categories: completion of treatment summaries within 90 days of end of chemotherapy, and assessment of patients’ emotional well-being by the second office visit. These measures were identified because prior use of QOPI measures had resulted in below average scores.
The researchers set up three tiers of success for each category. For those goals involving treatment summary completion, tiers I, II, and III were defined as completion of 15%, 25%, and 40% of medical records as measured by an internal audit. To measure the patients’ emotional state, tiers were arranged at the 75th, 80th, and 85th percentile of national QOPI aggregate data. Year-end payout was derived by combining variable compensation goals driven by three levels of percent base salary: 8%, 12%, and 24%. The probability to reach each goal was set at 90%, 50%, and 10%, respectively. Data were collected during spring and fall of 2012.
Upon auditing, it was found that 40.54% of medical records had included treatment summaries, resulting in achievement of tier III compensation. The researchers noted that documentation of the emotional well-being of the patient was found in 63% of cases. The national benchmark also improved, however, making this insufficient to achieve tier I.
The authors wrote that the QOPI measures could be used for physician compensation, especially in a variable compensation plan because “the information collected was quantitative, readily measured and understood, and could be compared objectively with the performance of others on a national scale.”
Ultimately, the division planned to use QOPI measures as a tool in the variable compensation program moving forward. They note that the measures would be more useful when used to address deficiencies or new activity that has been implemented. The authors state that “QOPI can be a long-term part of hematology-oncology variable compensation plans.”
Source: Makari-Judson G, Wrenn T, Mertens WC, Josephson G, Stewart JA. Using quality oncology practice initiative metrics for physician incentive compensation. J Onc Prac
. 2013; Oct 22. [Epub ahead of print]