By R. Shane Jackson, President, LocumTenens.com, www.locumtenens.com
As the health care industry moves toward a value-based reimbursement system, health care organizations – and the physicians who work for them – will need to better align their efforts to ensure a successful transition away from the current fee-for-service model. The 2014 Health Leaders Media Industry Survey found that 72 percent of health care leaders believe the industry will switch from volume to value. In the same survey, leaders listed physician-hospital alignment as the top area in most need of improvement to achieve financial targets.
With the focus on improving value by reducing costs and improving care quality, what should health care facilities consider to improve their physician alignment efforts, and how can physician recruiters help? As part of its annual Compensation and Employment Survey, LocumTenens.com surveyed doctors and asked them to rate physician-organization alignment efforts around quality metrics and patient satisfaction measures. The survey revealed some telling information that can help health care organizations better align their goals and metrics with physicians already on board. Physician recruiters, as gatekeepers, can use this information to select physician candidates who are the best cultural fit for their organizations. This is especially important because cultural conflict was listed as one of the top five reasons physicians quit in a recent American Medical Group Association (AMGA) survey.
What physicians think about clinical metrics
Physician-employer alignment is vital to many candidates. If they don’t feel they are on the same page as their organization, they may consider searching for employment elsewhere. According to the LocumTenens.com survey, more than two thirds of respondents said they felt they and their employers were aligned when it came to patient care metrics, leaving nearly a third feeling they were not aligned. The number one reason physicians did not feel they were aligned was that they believed their employers placed an undue emphasis on productivity and/or profits over quality.
“My network is interested only in the metrics that will be paid by insurers and the government and cares not whether those metrics reflect an improvement in the quality/quantity of patient life,” said one general practitioner. Similarly, a surgeon stated, “There is a disconnect between the business sense of the bottom-line productivity numbers and what really matters clinically for the patients.”
The second most-cited reason for a lack of alignment was a sort of standards mismatch or ineffective metrics. Some of the physicians in this category said the metrics were not designed for their specialty or measured variables outside of their control. Other respondents simply said there were no clinical metrics established at their place of work. Physicians were also asked about their involvement with developing policies and procedures at their place of employment. Only 34 percent of respondents were satisfied or very satisfied, demonstrating that physicians want to play a part in determining the metrics in which they are measured.
What physicians think about autonomy and accountability
One of the considerations physicians take into account when deciding on a place of employment is the amount of autonomy they will be allowed. More than 65 percent of surveyed physicians were satisfied or very satisfied with their current level of autonomy. Physicians who had previously been in independent practice were considerably less satisfied with their autonomy, 56 percent, compared to physicians who had always been employed, 72 percent. This is to be expected, but hospitals and large practices should be aware of how autonomy is treated with previously-independent physicians, who are used to calling their own shots.
Physicians have also expressed concern about accountability, specifically, being held accountable for variables outside of their control. Nearly 66 percent of physicians were satisfied with their accountability for patient outcomes. In contrast, only 53 percent were satisfied with their accountability for patient satisfaction scores. In write-in comments, several respondents expressed frustration with having patient satisfaction scores be a measure of their effectiveness as clinicians. One Ob-gyn said, “I feel we are too quick to choose pleasing the customer over evidence-based practice.” It is necessary to communicate with the physician candidate about the possible impact of patient satisfaction metrics on his or her compensation, if any are in place.
How physician recruiters can influence alignment
There were many positive takeaways from this study—physicians have a high level of commitment to clinical quality, and they are ready to partner for improvement. They are also generally accepting of the level of accountability to which they feel they are held. Physician recruiters can use this information to better inform candidates of their organization’s culture, especially around accountability, productivity expectations and autonomy, to ensure a better match. A few tips include:
- If your organization incents or penalizes physicians due to patient satisfaction scores, bring that up during the interview process to gauge how a physician feels about it.
- Review contracts with physicians and explain in-depth how compensation is tied to productivity and quality measures to ensure you are on the same page from day one.
- During the interview process, find out if candidates’ expectations for autonomy fit with your organization’s culture.
- One final note: More organizations are aligning compensation around quality outcomes and patient satisfaction scores. The latest data from the MGMA Compensation and Production Survey found that of primary care physicians who indicated they were compensated for quality, 3 percent of their compensation was based on those metrics. Specialty physicians reported that slightly below 2 percent of their compensation was based on quality metrics. As the pay-for-quality movement continues to grow in the health care industry, expect more physicians to be interested in quality compensation metrics. A 2012 Health Affairs article revealed that Geisinger Health System already pays more than 800 of its physicians a base salary that is approximately 80 percent of their total, with the other 20 percent being a twice-a-year installment if they meet their individual cost and quality goals.