For individual physician performance, the percentage of organizations that linked at least some of their incentives to quality increased to 86% in 2013, compared to 77% in 2012; and for patient satisfaction, it was 70% in 2013, compared to 66% in 2012.
Group performance metrics in physician incentive plans also showed similar payment related to quality and patient satisfaction in their incentive plan metrics. About 69% of those organizations linked payment to quality in 2013, compared to 56% in 2012; and 60% in patient satisfaction in 2013, compared to 50% in 2012.
Physicians are facing obstacles as they move toward improved quality and a "growing list of new demands" that include learning new EHR systems for new cost and business models, Otto says, adding that these trends influence how employers want to address compensation increases.
Designing incentive plan packages may be difficult, Otto says. Pay plans may involve complicated clinical structures such as ensuring vaccinations in pediatric practices or treating adult diabetic patients. They may result in measurements of not only long-term processes of care, but also outcomes. "It's a big challenge everyone is facing, with outcomes-based performance measures," he says.
Overshadowing incentives for physicians is the question of declining reimbursements and overall revenues.
"Among the issues coming down the pike is, 'How do you not only sustain current salaries, yet provide for increases?,'" Otto says. "I don't know the answer."