Public hospitals tie doc bonuses to performance

As new reimbursement models incentivize quality care, hospitals are compensating their physician workforce with the same pay-for-performance mindset.

The New York City Health and Hospitals Corporation (HHC), for instance, is now tying bonus payments for more than 3,500 employed physicians to performance on quality measures, the nation's largest public health system announced Saturday.

Performance benchmarks include lower readmission rates, more coordinated primary and preventive health services, better communication with patients, shorter emergency room wait times, and more efficient operating rooms, among others.

"By setting these improvement targets and awards, we more actively focus and facilitate the collaborative work necessary to render better care, while also shoring up the financial viability of our system going forward," HHC President Alan D. Aviles said in a statement.

Of the potential $59 million in incentive payments, HHC would allocate $13.75 million to the Mount Sinai School of Medicine physician group, $14 million to the New York University School of Medicine physician group and $31.3 million to the Physician Affiliate Group of New York group over the next three years.

The "unprecedented" program awards incentive payments to physicians as a group at each hospital, but that would allow even the worst doctor to collect bonus dollars, The New York Times reported.

Moreover, skeptics worry that performance incentives will lead to doctors manipulating the system for extra payments.

"If you take blood pressures three times and report the lowest, is that lying or merely tipping the numbers in your favor?" David U. Himmelstein, professor of public health at the City University of New York and a visiting professor at Harvard Medical School, told the Times.

Pay-for-performance critics have voiced similar concerns with financial incentives. A BMJ group analysis of seven pay-for-performance studies last year found that financial incentive programs "can undermine motivation and worsen performance," warning that physicians can game the system by misleading reports.

In addition to the risk of exploitive behavior, strict Stark law and anti-kickback statutes have been keeping some health systems from implementing quality and efficiency incentive programs.

For more:
- read the NYT article
- here's the HHC statement