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  • CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3073
    Joined: 01/03/2017
    Earnest refinancing bonus
    The problem with metrics is their design and use has been turned into a “weapon”, rather than a “tool”.

    Click to expand…

    The biggest problem with metrics is that a large majority of them are completely useless. Not only are they useless but a significant amount of time and resources are spent to manipulate them to make them look better.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #223057 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3380
    Joined: 09/18/2018

    Role reversal:
    Practice specific data collection to identify potential practice improvements. “I told you radiology was slow”, radiology has data documenting turn arounds.
    Misconceptions can be clarified or problems fixed.
    Hospital admin is “What can we do to make healthcare better?”.
    Why does the question of pregnancy show up on a male health history? One more box. Why does a child have “Any falls”? Seriously, a shotgun approach due to data collection needs to be fixed. The benefit of data collection is off target. That should be the next step. Buy in won’t be necessary. Providers will flock to productivity tools.
    Wishful thinking.

    #223081 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    I’ve noticed the same thing as, Wideopenspaces.   When I leave the job is when the administration is suddenly very eager to give in to my requests — unfortunately by that point it’s too late.   I’m not going to threaten leaving until I’ve reached the end of my rope and I have another offer lined up.  And by that point I might as well go ahead and leave.   Unfortunately, as employed physicians, it seems that our only leverage is to leave.   It’s a bad situation for everyone, including the patients, as often a non-compete requires that their physician move out of the area and non-competes have become ubiquitous.

    I would encourage everyone to ask their state legislators to follow Massachusetts and California lead in banning non-competes for physicians and other healthcare professionals.

    #223097 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    Great thread…

    As I try to balance the work in my organization, I recently proposed a “Physician Quality Bonus” be structured for certain meeting attendance and participation in committees. Thought this would improve engagement, improve buy-in to new projects, increase collaboration between nursing leadership and physicians, while showing physicians that we value their time and opinion.

    I am getting some push back from a c-suite member that it is not a “quality” measure however I think with improved engagement comes reduced burnout, improved quality through new initiatives and education. They want me to add back in “patient satisfaction scores” which I am looking into to see if the same docs continue to get the bonus based on good scores and the same docs continue to not bonus, due to bad scores…. just not sure this bonus really moves the needle. Thoughts? Do you think tying the bonus to patient satisfaction actually improves the interaction between patient/doc?

    How else would you want your Quality Bonus earned? This is not a huge chunk of money but it is an additional $15K/physician (different from production bonuses).

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    i agree that’s attendance is not a quality measure, but it may still be of use for evaluating clinical performance in some part.  we used it for a while for what the rank and file termed noneconomic credentialing.  if you failed, you were at risk for losing your credentials.

    c-suite level quality measures tend to be more process or outcome driven.  they tend to focus on overarching goals which are not easily influenced by individual physician activity.  they are generally more applicable to population based approaches to health care rather than individual patient performance.

    our experience with patient satisfaction scores are that definitely the same physicians did well year on year.  not sure that they were better physicians, but the scores were internally consistent and reproducible year on year.  if someone fell significantly off, we knew that there were some kind of personal trouble brewing or health issues or something.  the answer to whether it improves interaction is highly debatable.  i’m going to say a qualified yes- even say er doc to er doc there were wide variations which we attributed to teaching to the tests.

    how would a worker bee want the quality bonus earned?  something meaningful to their specific population of patients that is directly under their control.

    #223107 Reply
    Liked by SLC OB
    SLC OB SLC OB 
    Participant
    Status: Physician
    Posts: 616
    Joined: 06/23/2018
    It’s not worth a physician’s effort for $15k.

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    Since we discuss on here how bad many physicians are with money… those may not think so.

    You are right, it is not a ton but it is in addition, meaning it is NOT a clawback, which is unusual, as noted by SValleyMD:

    (unless it’s not at-risk money which it rarely is)…

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    We have about 20% of our docs taking time to attend these meetings, provide valuable feedback and help to move forward evidence based medicine. I was trying to reward those 20% and get more physicians engaged without measuring how many of your patient’s HgA1C has been drawn recently or if your mammogram rate is >XX%, or if you have screened every patient for smoking cessation and placed a referral, etc. Thought if I started with team play and collaboration, we would have more buy-in with projects, etc. Just trying to do something different, think outside the box and not just “You must have your charts closed within 24 hours or no bonus for you!”

     

    #223265 Reply
    Liked by Zaphod, Tim
    SLC OB SLC OB 
    Participant
    Status: Physician
    Posts: 616
    Joined: 06/23/2018
    something meaningful to their specific population of patients that is directly under their control.

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    That’s why I thought the meetings would help.

    For instance: an ED doc might be interested in decontamination training, participating in our “Active shooter” drills, etc.  A doc who has recently been through a lawsuit may want to be trained in “Disclosure of unexpected outcomes” and in turn be an Physician Champion to help other docs with disclosures. Cardiologist who is interested in expanding services might be interested in the ad hoc committee re: new echo equipment, developing cardiac standard practices and quality metrics to make sure our PCP are ordering the right tests/meds. etc….

    #223267 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3073
    Joined: 01/03/2017
    Physician Champion

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    Know how I know you do administrative work…? 😉

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #223268 Reply
    Liked by Tim, ZZZ, SLC OB
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2150
    Joined: 01/15/2017

    Here’s a ‘throwback’ from the Mayo — they’ve since developed a whole leadership curriculum off of this.

    https://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/pdf

     

    #223290 Reply
    Liked by SLC OB
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3380
    Joined: 09/18/2018

    Cardiologist: new echo under utilized.

    Admin- we think it’s lack of standard practices and PCP’s are screwing up..
    Cardiologist, great. Let me know when you fix the PCP’s screwups so I can do my job.
    Cardiologist and PCP’s would both like new echo machine delivered with standard practices and training provided by admin. Then the question, do we need metrics? Adhoc committees are great to “review” change management. The admin seems to be the project manager that “assigns” the “action items” for the next meeting. Then again, the Adhoc committee might add more metrics for the Cardiologist too.
    Many times, committees spend time educating committee members or justifying those that have no expertise, but represent groups that have only a stake in “participating “.

    This is not intended as a criticism, but the conclusion of more “metrics” for PCP’s seems to be critical for success in some people’s minds. More meetings and more metrics doesn’t mean success.

    #223294 Reply
    Liked by snowcanyon, Zaphod
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017
    something meaningful to their specific population of patients that is directly under their control. 

    Click to expand…

    That’s why I thought the meetings would help.

    For instance: an ED doc might be interested in decontamination training, participating in our “Active shooter” drills, etc.  A doc who has recently been through a lawsuit may want to be trained in “Disclosure of unexpected outcomes” and in turn be an Physician Champion to help other docs with disclosures. Cardiologist who is interested in expanding services might be interested in the ad hoc committee re: new echo equipment, developing cardiac standard practices and quality metrics to make sure our PCP are ordering the right tests/meds. etc….

    Click to expand…

    Meeting attendance is still not a quality metric as c-level suite people see them.  The concept is fine, but if your assignment is to generate quality metrics, this is unlikely to satisfy them.  I think you are working on a different project than what you were asked to develop.   If you want to reward physicians for participating, pay them for their time in the meetings and the prep time for the meetings.  If possible, block clinical time to allow them to prepare reasonably for these meetings without adding stress.  For the bigwigs, quality metrics are length of stay or readmission rate or a1c.

    Some people are wired to be helpful and make their communities better.  Like in freakonomics, if you operationalize it, you run the risk of turning social etiquette on its head.  People who might have volunteered might now feel like it’s more okay to decline if you don’t want the extra money.

    If you want to think outside the box, that’s laudable.  It sounds to me like the first step is to convince the c-suite that thinking outside the box is okay.  That may mean convincing them to adopt non-quality metrics for bonuses.  I think that is more likely than convincing them that the ideas you propose are actually quality metrics without more bones in either a process or outcome that is more directly attributable to something they are directly responsible for.  I think eventually most physicians either switch to c-suite type thinking (rank and file call it selling out) or burnout because it’s hard to be the bridge and have both sides think you are not helping.

    jmo.

    ymmv

     

    #223315 Reply
    Avatar ZZZ 
    Participant
    Status: Spouse
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    Joined: 06/18/2018

    “That may mean convincing them to adopt non-quality metrics for bonuses. ”

    If you can show them they’ll pay out less of those bonuses than they currently do, they’ll be all for it.

    “We have about 20% of our docs taking time to attend these meetings, provide valuable feedback and help to move forward evidence based medicine”

    If the meetings were truly worth their time, attendance would be far higher. Want to get attendance to 80%, pay the docs their hourly rate for coming.

    #223317 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3380
    Joined: 09/18/2018

    @SLC OB,
    “provide valuable feedback and help to move forward evidence based medicine.”

    My comments reflect my ignorance of medicine. But, change management has some common issues. One is productivity. Face it, the physicians on your staff have some serious talent. Problem solving is one of their strongest skills, years in the making. Not attending is a message. The “meeting” itself is viewed as inefficient because it’s primarily perceived as an activity trap. It saps time listening to feel good goals with zero meat. Now, have an adhoc committee to “streamline metrics by 50%” and what do you think attendance would be?

    Would admin agree to let physicians set the rules and standards? Like a survey ranking the satisfaction with each meeting?

    I greatly respect your skills and experience. Built into the process is that management by default is “right”, until 80% of the producers don’t show up due to lack of interest or relevance to their jobs. Throw some real meat on the table, you will need a bigger room. Bonus isn’t going to fix the problem. One meeting on the new echo machine. Head of Cardiology and PCP’s and the cardiologist. Standards of protocols and procedures by the former and the latter. Second meeting for signoff. It’s a go and move forward. You are the facilitator that brings the correct process owners together to solve the under utilization. The cardiologist will absolutely adore you. You facilitated department changes for everyone’s benefit. Unfortunately, no adhoc committees were needed for your admin colleagues to parade as improvements. The hospital is better off because you were responsive. That cardiologist will go to whatever meetings you need his attendance. Got your back.

    Your skills are valuable as the intermediary. It’s purely results oriented, not meetings. It’s simply you make life easier, it will be appreciated.

    #223346 Reply
    SLC OB SLC OB 
    Participant
    Status: Physician
    Posts: 616
    Joined: 06/23/2018

    Here’s a ‘throwback’ from the Mayo — they’ve since developed a whole leadership curriculum off of this.

    https://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/pdf

     

    Click to expand…

    This is super helpful as my CEO just watched The Mayo Clinic on Netflix… This may help. Appreciate it!

    Do you work at the Mayo?

    #223515 Reply
    SLC OB SLC OB 
    Participant
    Status: Physician
    Posts: 616
    Joined: 06/23/2018
    but if your assignment is to generate quality metrics,

    Click to expand…

    This is was not my assignment. We have this “Physician Quality Bonus” that currently gives you $$ for chart closure within 24 hours, patient satisfaction and some quality metrics that are useless. (split 1/3, 1/3, and 1/3).

    I just wanted to take the $$$ and use it for something besides those things.

    My medical staff lives in our area because they love to get out of the office/hospital and spend it hiking, mtn biking, skiing, swimming in our Alpine lakes, SUP, or spending time with family or friends. So if they can run/swim/bike for 2 hours before they go into office, instead of going to a meeting, they will. That is where I was trying to at least entice them to come in….

    We’ll see if I can get it pushed through (the key physician leaders I have spoken to like the idea) and if it works. It is only for one year… so not a huge loss if it bombs.

    #223522 Reply
    Liked by Zaphod
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2150
    Joined: 01/15/2017

    Here’s a ‘throwback’ from the Mayo — they’ve since developed a whole leadership curriculum off of this.

    https://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/pdf

     

    Click to expand…

    This is super helpful as my CEO just watched The Mayo Clinic on Netflix… This may help. Appreciate it!

    Do you work at the Mayo?

    Click to expand…

    Much warmer place —  University California- San Diego.   Though I wish we were as progressive in getting in front of the burnout issue.

    #223523 Reply
    Liked by SLC OB

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