Designing compensation incentives is complicated. That's the main takeaway from a recent study published in the Annals of Family Medicine that looked at how primary care physicians responded to individualized versus clinic-based pay-for-performance systems.
For the study, researchers from the George Washington University (GWU) School of Nursing in the District of Columbia and the University of Oregon's Health Policy Research Group conducted 48 interviews with clinicians in primary care clinics engaged in pay-for-performance initiatives at Fairview Health Services, a Minneapolis-based nonprofit academic health system.
Overall, most of the clinicians surveyed (73 percent) believed there should be a mix of clinic- and individual-level incentives to maintain collaboration and recognize individual performance. While Fairview did adopt a hybrid incentive program in 2014, according to AAFP News Now, it's instructive to examine some of the strengths and weaknesses discovered about team-based incentives during the study period.
Physician-reported drawbacks of pay based on clinic-level performance (representing 40 percent of physicians' base pay) included the following:
- Lack of control over compensation dependent on colleagues' performance
- Friction among colleagues, in some instances, which included some physicians berating others who weren't reaching goals and others leaving the organization
- Perceived unfairness that lower-performing clinicians could "ride coattails" of higher performers
Interestingly, a number of the clinicians who described the weaknesses of the team-based model also detailed the model's strengths, noted AAFP. A feeling of "not wanting to be the doctor who costs the others money," for example, was cited as a reason providers pushed themselves harder and improved overall performance.
One of the deeper changes driven by team-based incentives, according to lead author Jessica Greene, Ph.D., professor and associate dean for research at the GWU School of Nursing, was that it encouraged providers to get out of their silos and learn from one another. One clinician, she explained, described seeking out colleagues with high-quality metrics and asking them, "What are you guys doing that's different than I'm doing?"
"Those types of interactions seem very important, and I wonder what else could spark them without a team-level financial incentive," Greene asked AAFP News Now.
To learn more:
- read the post
- see the study