Hospital Incentive Bonuses

[doesntbodewell]

What are others’ experiences with incentive bonus requirements?

I’ve spoken with a few other groups I know of about having a quarterly incentive bonus in the anesthesia group contract with the hospital.
They’ve had variations from the group hitting easily obtainable units/qtr to obtaining easy QI goals like PONV treatment or patient temperature mitigation strategies.

Our group has a quarterly incentive to produce a pre approved quality improvement project with data and packet submission or a multi departmental policy implementation EVERY QUARTER!

Is this a normal practice for hospitals since the big push for incentivizing payments years ago?

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[Dr. Rude]

 

[GassYous]

What is this, residency?

 

[nimbus]

No. But I think our pharmacy must have one. They’re rolling out new initiatives and reinventing the wheel ALL THE TIME. The most suspenseful part of our monthly department meeting is the presentation of the “project of the month” by pharmacy.

 

[IlDestriero]

I don’t see how you could produce a QI project per quarter. That’s ridiculous. You need months to plan, train, implement, review, etc. You’d have to have multiple projects in different phases of development and implementation all the time. Unless your place is the Wild West where everyone is going rogue and needs to implement basic guidelines, etc. I don’t see how that’s possible. And I definitely wouldn’t want to tie that nonsense to my bonus.

 

[Anesthesia_Guy]

Epic stupidity.

 

[pocafx]

We have goals like you mentioned.
Pacu temp above 36.0. Appropriate PONV ppx. tylenol for specific patients

 

[cchoukal]

I'm with those above; to really do quality takes a lot of effort. The biggest things are figuring out where you are and then whether you've improved, and if you don't have resources for tapping and analyzing data from your EMR, the whole thing is kind of pointless. The whole world is moving toward more of your money being "at-risk" based on behavior (in this case, part of your salary that you used to just get is now being withheld pending analysis of your behavioral alignment with hospital goals nebulously defined as "quality"), so we shouldn't be surprised. I think maybe our group gets a tiny chunk of theoretically extra money for meeting some quality goal that we get to define in conjunction with the larger perioperative apparatus, but the amount is very small and I'm not at the table, so not sure what will come of that. I imagine we can all expect to see more of this kind of thing in the future, and it CAN be a good thing. If we are properly resourced to measure outcomes and select actual, clinically relevant behaviors, AND get money for it, it can be a win for everyone.

 

[jwk]

We have goals like you mentioned.
Pacu temp above 36.0. Appropriate PONV ppx. tylenol for specific patients

But that's SOP stuff. We don't get anything extra for it.

 

[psychbender]

At my previous, hospital- employed, job, the hospital came to the group with a proposed yearly bonus based on quality metrics that we were allowed to determine ourselves. We picked some low- hanging fruit that should be super easy to achieve and track, and the hospital agreed. Fast forward to the end of the year, and no one received any of the bonus. The rationale? "We couldn't figure out how to track those things, so can't give you the bonus." At about the same time, the health system was trying to renegotiate the employment contracts, and wanted to decrease the base pay, but double the bonus! Needless to say, the department told them to **** off with that proposal.

 

[pocafx]

But that's SOP stuff. We don't get anything extra for it.

Yes that’s the point. Tie “quality” metric to something we already do and thus we always meet the metric.

 

[IlDestriero]

I’ll add that we also have these mandated qi metrics (1 a year, not one a quarter). There are institutional ones (like CLABSI rate), group ones, and individual ones.
We select our own group and individual metrics and pick easy to comply and track ones. The hospital doesn’t care as long as we are doing it. They are tied to our bonus only, and the amount of money at risk is only ~1% of our income combined. So if the CLABSI rate is high by 0.2% they can say we have skin in the game, but not really enough to be impacted in any way.

 

[kidthor]

At my old job the hospital kept coming up with absurd metrics and projects that they forced on us (my dept leadership was a willing pawn). A favorite of mine was our dept constantly being blamed for essentially any post op infection. It got so convoluted that for SSIs they’d blame us for not checking a glucose on basically every patient - including non-diabetics, and suggesting they must have been hyperglycemic and unrecognized/untreated, thereby causing the SSI.