Prevalence and Basis of Performance Incentives for Hospitalists

Background:

Hospitalists are increasingly being asked to comply with performance measures related to quality of care, efficiency, and patient satisfaction. Overall, little is known about existing incentives to reward hospitalist performance outside of professional billings. The purpose of this study was to determine the degree to which hospitalist groups are using performance incentives and to describe the specific details of these incentives.

Methods:

In the fall of 2006, hospitalist group leaders who were members of the Society of Hospital Medicine were surveyed on performance incentives for their groups. Questions addressed the prevalence of performance incentives, whether the incentive was applied to the group or individual, the basis of performance goals, and the financial impact of the incentives.

Results:

Of the hospitalist group leaders, 41% (60 of 146) reported that their group has performance incentives in place. For 43% with such incentives, the incentive was tied to individual performance, for 35% it was tied to group performance, for 10% it was tied to a mix of group and individual performance, and for 12% were unsure. Incentives for JCAHO/CMS Core Measures for pneumonia and heart failure, measures for “citizenship,” patient satisfaction, and transitions of care were used by 50%‐75% of hospitalist groups, and 24%‐49% of groups utilized the JCAHO/CMS Core Measures for myocardial infarction, measures related to hospital throughput, avoidance of unapproved abbreviations, and compliance with medication reconciliation. For performance goals, 60% and 23% of group targets were based on national and local benchmarks, respectively, 37% were based on the hospital's previous experience, and 47% were based on improvement over baseline. For incentives as a percentage of total compensation, 40% reported the incentive was 7% or less, 35% reported it was 8%‐10%, 20% reported it was more than 10%, and 5% did not know the financial impact. The median was 8%‐10% of total compensation.

Conclusions:

Fewer than half, or 41%, of hospitalist groups have performance incentives in place. The basis for the incentives was largely derived from JCAHO/CMS Core Measures and National Patient Safety Goals for hospitals. Performance measures for patient satisfaction, throughput, and “citizenship” also were important. The financial impact of these incentives in most cases was a significant portion of total hospitalist compensation.

Author Disclosure:

W. Whitcomb, none; P. Torcson, none.