MD Incentive Compensation Alexa B. Kimball, MD, MPH Medical Director, Mass General Physicians...

MD Incentive Compensation

Alexa B. Kimball, MD, MPHMedical Director, Mass General Physicians Organization

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MGH 1811 Corporation

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Massachusetts General Physicians Organization (MGPO)Organization and History

Formed in 1994 from 3 existing MGH physician groups.

Governed by a Board of Trustees, half of whom are lay members.

Includes 2,700+ physicians with clinical appointments, almost all of whom are employed by the MGPO.

Formed in 1994 from 3 existing MGH physician groups.

Governed by a Board of Trustees, half of whom are lay members.

Includes 2,700+ physicians with clinical appointments, almost all of whom are employed by the MGPO.

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Compensation History

Compensation plans rolled out across departments over past 10 years; most have a productivity component

Quality Incentive Program introduced in 2006 2 Terms per year/3 measures per term

Departments also may have some incentive based plans

Internal Performance Framework introduced as we moved increasingly into risk contract

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Physician Compensation & IncentivesChallenges

Change • Reducing the relative

compensation for clinical productivity to fund other incentives (population management, quality, management of TME, etc.), without reducing professionalism, morale, sense of autonomy/mastery, work ethic.

Danger of “Monetization” • Protecting the commitment to

education and academics.

Physician perception• The independent contractor• The cog in the machine

(neither is ideal)

Low HighRelevance of Incentive to

Individual Physician

Easy

Hard

Abil

ity

to M

easu

re

MGPO

Department

Center

Unit / Practice

Individual Doctor

Department

QI program

IPF

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Overall. 18th program term, 1,940 eligible clinicians

Performance by measure. Population health management: 99% met the target Joint Commission training: 98% met the target Department measures: 29 measures, 91% of MDs met

their target

Communication. Results in a personal email, online, and in the June

Fruit Street Physician Payment is in the June paycheck

QI HighlightsResults for Term 1, 2015

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*This chart may overstate results for small groups.

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Internal Performance Framework

Forcefield effect Strategy Trend Quality

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Not done yet: Taskforce Recommended Principles 2014

General: Improve clinical care or contribute to mission Consistent with an ethical framework of practice for physicians

Compensation Comp plan structures should be transparent, consistent and

fair Chiefs should have some discretion over comp components Comp plans should be adjustable over time to market forces

and support recruitment and retention Productivity measures

Productivity incentives should be included in most compensation plans

Non-productivity measures Measurable Actionable Adjustable

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Recommended Implementation Principles

Incentives should be integrated in a manner that… Improve patient care Minimizes administrative burden Leverages MGPO QI program admin structure Recognizes and supports diversity in

compensation plans across and within departments

Ideally adds at-risk compensation while preserving current pay

Maintains compensation levels to recruit and retain world-class physicians

Creates opportunity to phase out historical metrics that may be outmoded