Public hospitals, doctors' union clash over pay for performance

The New York City Health and Hospitals Corporation (HHC) is clashing with union doctors over a new plan that ties bonus payments to performance on quality measures.

Pay for performance, encouraged by the government under the Affordable Care Act, links some of a doctor's paycheck to feedback from patients and metrics such as readmission. It replaces a previous compensation system that gave raises to all physicians across the board, replacing quantity metrics with quality metrics.

In early January, the HHC, the nation's largest public health system, announced it was tying bonus payments for more than 3,500 employed physicians to performance on quality measures.

"So-called pay-for-performance, announced in January, has set off a firestorm of debate in the medical community and is being closely watched across the country," The New York World reported. "New York City is the nation's largest public health system, and 16 hospitals and diagnostic/treatment centers are affected."

The problem in New York is that some of the HHC's affiliation groups are technically the employer of public-hospital doctors. The Doctors Council SEIU, representing 2,000 of 3,300 doctors working in NYC's public hospitals, says it was left out of the conversation when the pay-for-performance decision was made.

"There was virtually no involvement by the union or members of the community about this agreement," Kevin Collins, the group's chief of staff, told The New York World. "Doctors have had little to no input." He noted they're not necessarily opposed to pay-for-performance; their argument is with the chosen performance indicators.

While Collins contends the agreement was made "between administrators," HHC representatives say physicians had a huge role in drafting the policy, according to The New York World. SEIU's Frank Proscia, M.D., said the union is seeking to renegotiate the agreement, noting doctors need to "respond as medically appropriate, not with an eye toward their next bonus."

Physician performance-based compensation has been gaining ground, with surveys in late 2012 revealing that 23 percent of 1,311 respondents said "value of care" was most closely tied to their income.

To learn more:
- read the report in The New York World