What’s in it for me? Incentive compensation in hospital medicine

Abstract

Objective: Though salary models vary, a portion of physician compensation is often provided as a bonus, or incentive payment, based on clinical productivity measured by the relative value unit (RVU). However, many hospitalists are involved in activities beyond clinical work, either administrative or educational, that may be difficult to measure and recognize in bonus payments. Furthermore, the changing nature of physician and hospital reimbursement necessitates a focus on quality measures not incentivized in the traditional RVU model.Methods: The authors describe a compensation model in an academic hospital medicine program that was initially developed in 2010 and modified in 2013. The model incents clinical productivity and adherence to quality metrics while also promoting nonclinical academic and administrative activities.Results: Implementation of this compensation model impacted the division’s quality goals by increasing completion of discharge summaries, reconciliation of discharge medications, and placement of follow-up appointment orders upon discharge. The impact on clinical and academic productivity is less clear.Conclusions: A compensation model that accounts for academic productivity and quality goals along with clinical productivity may be useful in incentivizing hospitalists in both academic and community-based hospital medicine practices. Future work should focus on whether such a model can be used effectively to address additional targets such as reducing readmissions and preventing hospital-acquired conditions.