As hospitals, health systems, 和学术医疗中心(amc)开始评估他们的第一个系列的bet8网站备用交易(如.g., employment, Professional Services Agreement [PSA]) that occurred during the past 3 to 5 years, many are now revisiting the fundamentals of physician compensation. 大多数组织面临的主要挑战是制定bet8网站备用激励措施,以推动生产力和质量,同时确保薪酬保持在组织的财政现实基础上——这是计划设计中经常被忽视的一个方面.g., during the 1990s). As such, 过去仅将薪酬指数与基准挂钩的方法的长期财务可行性.g., 每个WRVU的补偿中位数)和假定bet8网站备用承担全部财务风险的做法开始受到质疑. 虽然补偿计划最终将取决于当地市场情况和偿还办法的演变, below are five emerging trends to watch nationally.
1. Community and Clinical Faculty Compensation Have Yet to Merge
With perhaps the exception of major service lines or centers, 社区bet8网站备用和临床教师的薪酬模式和目标的设计仍然是截然不同的. 许多拥有大量受雇社区bet8网站备用的amc目前专注于巩固基础设施,并没有看到迫切需要确保学术和非学术bet8网站备用之间的平等. This trend is highlighted by survey data (see figure below), 在过去的5年中,大多数专业报告的薪酬显示出一致的差异. In some cases the gap may even be increasing, as with internal medicine, where the gap has averaged approximately $49,000 over those 5 years but increased to almost $60,000 in 2012. While there are many factors that may contribute to this income disparity (e.g., productivity, the use of residents and/or extenders, nonclinical duties), amc应该积极主动地设计混合补偿模式,以确保整个企业在临床补偿方面的一致性, as the consolidation of community physicians and clinical faculty will continue to rise.
2. Productivity-Based Compensation Continues to Be Dominant
Despite a renewed focus on quality and value, as well as the expectation that the market will migrate away from a utilization-based system, 基于生产力的薪酬模式几乎是高绩效bet8网站备用和顶级资产管理公司的标准. 而通过基于生产力的激励支付的总薪酬或预期薪酬的百分比各不相同, nearly two-thirds of providers pay over 50% of salary based on productivity. WRVUs remain the most popular metric used to measure productivity. Depending on the specialty, wrvu可以被更好地反映该专业目标的其他生产力指标所取代或增加.g., the number of new patients seen in the cardiology clinic). Additionally, WRVUs continue to be the prevailing metric used for PSA payment arrangements. Although WRVUs continue to be dominant, 组织应该开始考虑将可选择的特征混合到与其管理式医疗策略一致的薪酬模型中.g., 当报销从按bet8娱乐收费转向部分或全部风险安排时,支付给初级保健bet8网站备用(pcp)的费用(根据小组规模).
3. Quality Incentives Are Emerging Slowly
There is significant interest in attributing more compensation to quality-based components, partially in response to and in preparation for payment reform; however, these types of arrangements are still evolving. 许多bet8网站备用要么难以确定质量指标,要么缺乏准确跟踪这些指标的适当系统. For organizations that link compensation to quality metrics, the percentage of compensation tied to these metrics is relatively modest (i.e., approximately 5% to 10% of expected or targeted compensation). Nonetheless, this percentage is expected to grow, 组织现在应该采取准备措施,建立一个基础设施和流程来衡量和跟踪有形的质量指标,预计这些变化将对bet8网站备用的薪酬产生越来越大的影响.
4. Benchmarks Are a Necessary Guide but Are Not a “Price Sheet”
Defining market compensation continues to be a challenge, 几乎所有资产管理公司和bet8网站备用都利用一个或多个国家基准作为指导,以制定有竞争力的薪酬,并确保不超过公平市场价值. However, the tendency to adopt a single benchmark or percentile is fading. This stems, in part, 在这段市场整合期间,基准中反映的每WRVU数额的补偿不断上升(这使某些专业的补偿膨胀)。. In turn, 在bet8网站备用委员会要求降低/管理成本的压力加大之际,这导致每位bet8网站备用的损失上升. 基准可能起到指导作用,但本地交易实际上是在设定市场价值. 与我们合作的许多进步的bet8网站备用正在利用直接从同行组织和当地市场情报提供的信息扩充国家基准数据. Particularly during this time of rapid consolidation and change, 各组织不应仅仅依赖国家基准,而应准备根据当地的留用和征聘趋势以及从国家同类组织收集的见解作出假设和调整.
5. Links to Financial Performance Are on the Rise
While preserving productivity-based components and with an eye toward quality, 许多bet8网站备用正在采取更积极的方法,将奖励或风险补偿的支付与bet8网站备用组织提供的资源联系起来. In some instances, 随着每位bet8网站备用的损失在全国范围内持续上升,各组织正在将bet8网站备用薪酬与整体系统绩效联系起来. Common metrics include the ratio of collections to compensation, gross operating margin (collections less direct expenses excluding physician compensation), and overall net margin of the business unit/practice. 这种方法不仅支持了集团的财务可行性,而且还有助于消除人们日益增长的担忧,即bet8网站备用将从私人执业的成本意识转变为完全基于个人生产力的思维模式,因为他们以每个WRVU为基础支付报酬,而不考虑bet8网站备用组织和/或bet8网站备用的成本结构. Accordingly, 组织应该重新考虑只考虑生产力的薪酬模式,并积极寻求机会,根据财务业绩将部分薪酬置于风险之中.
Conclusion
Although not traditionally the case, bet8网站备用薪酬的方式正悄然成为市场差异化的一个来源. 将bet8网站备用激励与新兴的报销模式和组织的战略目标结合起来的组织, while building in appropriate financial safeguards, will ultimately have a competitive advantage in their local market. Furthermore, as the prevalence and cost of these arrangements grow, 组织将受益于采取积极主动的方法审查他们的bet8网站备用补偿安排, rather than waiting for the entire market to shift.
Published November 7, 2012