Hospitals and health systems also are learning about at-risk payments. Higher percentages of employed physicians are being compensated for clinical quality and patient satisfaction metrics, and the level of incentive is increasing, too. Now, 17% of respondents report that compensation for clinical quality and patient safety for employed physicians is in excess of 10%. That percentage will increase to 44% in the three-year time frame.
"That's something that we're all going to be emphasizing over the years to come," says Stoyanoff. "Employing physicians is still an expensive endeavor, so even in an employment model, we like to have a portion of their salaries at risk for performance targets." Again, she recognizes learning opportunities when establishing at-risk incentive programs: "It's making a lot of organizations struggle because we don't necessarily know how to go about establishing those metrics, or have experience tracking them, or even know which ones we should choose, but it is something that we're all going to concentrate on."
Deveny notes that early steps are being made with physicians, steps that include accountability and data-based decisions. As relationships mature, he says, "We all have the obligation to show our value to our communities and to the people who are going to be purchasing healthcare."
Deveny anticipates a patient-as-consumer focus. "Medicare Advantage is a good example," he says. "One by one, you've got to convince every one of those enrollees that they want to give up Medicare and move to your Medicare Advantage plan, and you're going to have to have strong reasons for them to move. That's why I say physicians can't be passive. We won't be in the income preservation business anymore. We've got to require more out of both parties, but then the health systems have got to be just as accountable to the physicians on performance."
This article appears in the September issue of HealthLeaders magazine.