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+++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++ PRACTICE NOTES ❯ How to Best Evaluate and Incentivize Your Group of Physicians By Timothy DiBona IT IS TIME TO adopt a quality- driven incentive model for your group of providers. In the past, the relative value unit (RVU) model was a decent way to determine productivity, which was central to increasing income for a fee-for-service model. We are well on our way to a quality model, but we still have significant weight with the ser- vices being provided. You need your doctors to be able to identify what constitutes a high-income model for today — not yesterday's service model and not tomorrow's quality model. Start by setting up some simple benchmarks. Do not overcomplicate a new system. Set your desired target and your minimum expectation. This will create three graded levels of success. This new model shouldn't eliminate RVU reports. But perhaps it is time to change some of the point values to properly account for disparities with your practice. If you have nocturnists, weekend shifts or low-volume depart- ments, adjust values accordingly. Someone skilled in RVU interpreta- tion will allow you to understand if your departments are overstaffed or if providers are miscoding their service-level billing. Discover the add-on service codes your providers are not utilizing on a routine basis. Evaluate these current procedural terminology (CPT) codes and determine the desired target and minimum acceptable quantities. Communicate these incentives to gain their interest and ensure they begin to capture these minor services. Communication is more essential now than it has been in the past 20 years. It is so important that groups are adding staff meeting attendance to their incentive pool. And why not? It may be critical for only a couple of years, but the doctors who miss more than one per quarter will find themselves falling behind their peers quickly. So set your minimum at two per quarter and the desired target at three per quarter. Have your group members meet directly with your billers on a quar- terly basis. If they cannot physically attend, arrange a conference call. Your billing staff should be able to graph each provider's successes and failings. A compliance expert can explain how to avoid missed charge opportuni- ties. He or she may also audit a few encounters that tie into concerns. Nothing teaches team members how to improve faster than seeing their own mistakes described for them. The measure here is attendance. Some of the leaders may lag behind in measures such as RVU, encounters per shift and average charge/collection per shift. This may be due to added duties such as committee work. If providers catch on that they are being beaten out on incentives because they are on committees, you should have a response ready for them. Now the quality incentives need to be added in. Many of these will change according to specialty, but everyone should be receiving them by now. If you have a private group work- ing in a hospital setting, you want to at least be on par with their development toward quality compliance. Patient satisfaction is a nice place to start. Surveys will allow you some insight into your providers' bedside manner and allow you to have more meaning- ful discussions during reviews. Length of stay (LOS) is still an evolving benchmark in facilities. Technology is available to determine LOS based on diagnosis. This is a flashy statistic if you can capture and share it with your peers or adminis- trators. Many 24-hour facilities are concerned about the penalties associ- ated with readmission within three or 30 days. Determine your group's position and share this information with the providers and the hospital. Create a plan for improvement. Unfortunately, it is often difficult to pin LOS or readmission on a spe- cific provider. Patients will typically receive service from multiple sources, and therefore, it is more practical to take a team approach and use a group average for the model. This may seem like a laundry list of incentives, but it is possible and practi- cal in today's climate. You can likely think of a few others for your particular operation. The most successful models in the country consist of a heavy incen- tive percentage for salary. Evaluate, communicate, then repeat. Timothy DiBona is the Business Director at Doctors' Management Service Inc. and the President of Salus Resource Group. He has collaborated with hundreds of physicians over the past 25 years. He believes in trust- first relationships fueled with consistent communication. He can be reached at Tim@ DoctorsManagementService.org. ■ 1 2 | Greater Boston MD NEWS ■ M D N E W S . CO M