作为医院, bet8网站备用, and academic medical centers (AMCs) begin to evaluate their first series of physician transactions (e.g., 就业, 专业bet8娱乐协议(PSA)),在过去3至5年内发生, 许多人现在正在重新审视bet8网站备用薪酬的基本原则. The central challenge for most organizations is to develop physician incentives that drive productivity and quality while ensuring that compensation remains grounded in the fiscal reality of the organization – an aspect of plan design that is often overlooked (e.g.(1990年代). 像这样, the long-term financial feasibility of past approaches that merely index compensation to benchmarks (e.g., median compensation per WRVU) and assume bet8网站备用 take on full financial risk are beginning to be questioned. While compensation plans will ultimately be shaped by local market conditions and the evolution of reimbursement methodologies, 以下是全国范围内值得关注的五大新兴趋势.
1. 社区和临床教师薪酬尚未合并
除了主要的bet8娱乐热线或bet8娱乐中心, the design of compensation models and targets for community physicians and clinical faculty remain distinct and separate. Many AMCs with a high number of employed community physicians are currently focused on consolidating infrastructure and have not seen an immediate need to ensure parity between academic and nonacademic physicians. 调查数据突出了这一趋势(见下图)。, showing a consistent variance with respect to reported compensation for most specialties over the past 5 years. 在某些情况下,差距甚至可能还在扩大, 就像内科一样, 哪里的差距平均约为49美元,在那5年里涨到了近60美元,000 in 2012. 虽然有许多因素可能会导致这种收入差距(例如.g.(生产力、住院医师和/或扩展人员的使用、非临床职责), AMCs should be proactive in designing hybrid compensation models that ensure consistency across the enterprise with regard to clinical compensation, 随着社区bet8网站备用和临床教师的整合将继续上升.
2. 基于生产力的薪酬仍然占主导地位
尽管重新关注质量和价值, 以及市场将从基于利用率的系统迁移的预期, productivity-based compensation models are nearly standard across high-performing bet8网站备用 and top-tier AMCs. While the percentage of total or expected compensation paid through productivity based incentive varies, 近三分之二的医疗bet8娱乐提供者根据工作效率支付超过50%的工资. wrvu仍然是衡量生产率的最常用指标. 取决于专业, WRVUs may be replaced by or augmented with other productivity metrics that better reflect the goals of that specialty (e.g.(心脏病门诊新就诊患者的数量). 此外,wrvu仍然是PSA支付安排的主要衡量标准. 尽管wrvu仍然占主导地位, organizations should start to consider blending alternative features into their compensation models that are consistent with their managed care strategy (e.g., payment to primary care physicians [PCPs] for panel size) as reimbursement shifts from fee-for-service to partial- or full-risk arrangements.
3. 质量激励措施正在缓慢出现
将更多的补偿归因于基于质量的组件是很有意义的, partially in response to and in preparation for payment reform; however, 这些类型的安排仍在不断发展. Many bet8网站备用 are either struggling to define quality metrics and/or lack the proper systems to accurately track them. 对于将报酬与质量度量联系起来的组织, 与这些指标挂钩的薪酬比例相对较小.e.(约为预期或目标薪酬的5%至10%). 尽管如此, 这一比例预计还会增长, and organizations should take preparatory steps now to build an infrastructure and processes that measure and track tangible quality metrics with the anticipation that these changes will have a growing influence on physician compensation.
4. 基准是必要的指南,但不是“价格表”。
定义市场薪酬仍然是一个挑战, and nearly all AMCs and bet8网站备用 utilize one or more national benchmarks as a guide to both set competitive compensation and ensure that fair market value (FMV) is not exceeded. 然而,采用单一基准或百分位数的趋势正在消退. 这是, 在某种程度上, from the rising compensation per WRVU amounts reflected in the benchmarks during this time of market consolidation (which is inflating compensation for certain specialties). 反过来, this is causing the loss per physician to rise during a period of heightened pressure from health system boards to reduce/manage costs. Benchmarks may serve as a guide, but local transactions are effectively setting market value. Many progressive bet8网站备用 that we have worked with are augmenting national benchmark data with information provided directly from peer organizations as well as local market intelligence. 特别是在这个快速整合和变化的时期, organizations should not rely solely on national benchmarks but be prepared to make assumptions and adjustments based on retention and recruitment trends locally and insight gathered from peer organizations nationally.
5. 与财务业绩的联系正在上升
同时保留基于生产力的组件,并着眼于质量, many bet8网站备用 are taking a more aggressive approach to linking the payout of incentives or at-risk compensation to the availability of resources through the physician organization. 在某些情况下, organizations are linking physician compensation to overall system performance as the loss per physician continues to rise nationally. 常见的度量标准包括收集与补偿的比率, 营业毛利(收款减去直接费用,不包括bet8网站备用补偿), 以及业务单元/实践的整体净利润率. This approach not only supports the financial viability of the group but also helps combat the growing concern that physicians will transition from the cost-conscious mentality of private practice to a solely individual productivity-based mind-set as a result of being paid on a per WRVU basis that does not take into account the cost structure of the physician organization and/or health system. 相应的, organizations should reconsider productivity-only compensation models and actively seek opportunities to place a portion of compensation at risk based on financial performance.
结论
虽然传统上不是这样, approaches to physician compensation are quietly becoming a source of market differentiation. Organizations that align physician incentives with emerging reimbursement models and the organization’s strategic goals, 同时建立适当的金融保障, 最终会在当地市场拥有竞争优势吗. 此外, 随着这些安排的普及和成本的增长, organizations will benefit from taking a proactive approach in reviewing their physician compensation arrangements, 而不是等待整个市场的转变.
2012年11月7日出版