Dealing with physician compensation based on quality outcomes is a thorny issue for hospitals and health systems; 59% report that they base bonus compensation for their physicians on their performance on quality measures, while fewer, 43%, link quality outcomes to standard compensation for physicians. Ranney’s not even sure that financial rewards are necessary to achieve quality alignment, however.
“Physicians generally will align to quality without incentives if they get data associated with it and they believe it,” he says. “However, the incentive helps you align the physician early on, so you get past the argument that the data is bad.”
For the majority of the respondents (58%), physician employment seems to hover between 1% and 30% of their medical staff, but many hospitals and systems report their employment of physicians reaches far higher than that level, and only 9% report no physician employment. Some 67% of respondents noted that they employ 30% of their physicians or less.
Ranney expects the trend to employ more physicians to continue for most hospitals and systems, although much of the desire for employment, he says, rests on the desire of younger physicians to structure their work that way. “We’re employing voluntarily and some nonvoluntarily because that’s what physicians want.” Still, he expects the majority of physician employment to be represented among primary care, hospitalists, general surgery, and cardiology, with other specialties only sprinkled in, for now, to fill gaps.
Even with the greater employment, physician alignment is no given, says Ranney, echoing survey respondents.