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  • SLC OB SLC OB 
    Participant
    Status: Physician
    Posts: 610
    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

     

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    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?

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

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    Nice! I have a lot of doc friends down there…. some I did medical school with and some in leadership. An anesthesia doc, ortho doc, and ED. Love to visit down there… my ED friends own a place on the water in Imperial Beach, so fun to go surf there (not that I can stand up for all that long!)!

    #223526 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017
    but if your assignment is to generate quality metrics, 

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    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.

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    i would have thought most people like to not be in the office/hospital when they don’t need to be.  encouraging them to come in for meetings still isn’t normally viewed as a quality measure, even if the eventual work product improves quality or productivity (as c-suite sees things) normally.  of course physician leaders love the idea.  who wouldn’t like to turn time you are already spending unpaid into time paid?  it’s definitely a win.  even more of a win if it is truly viewed as a physician bonus.

    in our area, when this discussion reaches a stalemate, usually a consultant is brought in, they warn the c-suite that this can’t just be a handout or else it should be considered part of the base income, consider whether this affects fair market value incomes, and if it is a bonus or just something that government would view as sidestepping compensation laws.  the physicians don’t have the time or expertise to really determine the validity and the bosses control the money anyways so it goes the way it’s always gone.

    at this point, i feel like we are talking past each other so i just will wish you luck.  i truly do hope you convince the c-suite of a mindset change which to me is more important than the 15k or whatever.

     

    #223562 Reply
    Liked by SLC OB
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3305
    Joined: 09/18/2018

    The intention is a positive step.

    “usually a consultant is brought in, they warn the c-suite that this can’t just be a handout or else it should be considered part of the base income, consider whether this affects fair market value incomes, and if it is a bonus or just something that government would view as sidestepping compensation laws. ”

    FMV is the actual cost. To get participation (considering the alternatives) some businesses have point system.
    10 points for free gear
    20 points for a nice coat
    Frequent flyer mile accumulate and are redeemed.
    Gold bypasses the lines. Keep the creative thoughts going. Consultants, participation incentives please.

    #223617 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3305
    Joined: 09/18/2018
    Earnest refinancing bonus

    “Much warmer place — University California- San Diego. ”

    Mayo addressed this issue as well. Phoenix is getting pretty big. I wonder if they have a 2-3 month rotation program or an in-house CME resort in Scottsdale.

    #223623 Reply
    childay childay 
    Participant
    Status: Physician
    Posts: 1070
    Joined: 01/09/2016
    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.

    Click to expand…

    i would have thought most people like to not be in the office/hospital when they don’t need to be.  encouraging them to come in for meetings still isn’t normally viewed as a quality measure, even if the eventual work product improves quality or productivity (as c-suite sees things) normally.  of course physician leaders love the idea.  who wouldn’t like to turn time you are already spending unpaid into time paid?  it’s definitely a win.  even more of a win if it is truly viewed as a physician bonus.

    in our area, when this discussion reaches a stalemate, usually a consultant is brought in, they warn the c-suite that this can’t just be a handout or else it should be considered part of the base income, consider whether this affects fair market value incomes, and if it is a bonus or just something that government would view as sidestepping compensation laws.  the physicians don’t have the time or expertise to really determine the validity and the bosses control the money anyways so it goes the way it’s always gone.

    at this point, i feel like we are talking past each other so i just will wish you luck.  i truly do hope you convince the c-suite of a mindset change which to me is more important than the 15k or whatever.

     

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    Gotta love them consultants

    #223662 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2128
    Joined: 01/15/2017

    @tim – yes, drove by in April during GC trip.  Big place.  The Music museum was a lot of fun.

    @q-school – this is where we are at current in our division.  Csuite brought in new MBAs two years ago with a 3P vision.  He left within a year and rest of the MBA infrastructure made a lot of rapid changes — all for the worse on burnout.   Rebellion started; people left/retired, got our physician leader forced resign and redesign in full swing now with — yep consultants brought in since didn’t want to return the keys to the docs to fully engage.  Let’s see how this turns out — but I swear I’ve seen this play before.

     

    #223789 Reply
    Liked by q-school, Zaphod, Tim
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    @tim – yes, drove by in April during GC trip.  Big place.  The Music museum was a lot of fun.

    @q-school – this is where we are at current in our division.  Csuite brought in new MBAs two years ago with a 3P vision.  He left within a year and rest of the MBA infrastructure made a lot of rapid changes — all for the worse on burnout.   Rebellion started; people left/retired, got our physician leader forced resign and redesign in full swing now with — yep consultants brought in since didn’t want to return the keys to the docs to fully engage.  Let’s see how this turns out — but I swear I’ve seen this play before.

     

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    I feel like this cycle happens everywhere over and over. It swings one way and then the other. Its good for docs for a while and admin sees a bunch of money on the table, they aggressively ramp up after it for a number of years resulting in dissolution of the structure that put it there in the first place, a reckoning occurs and suddenly the place is physician/patient centered, builds to good again and repeats.

    For the OP question, its not a quality measure but an engagement one, just being put under whatever definition pays for it. I think its great if it can drive engagement further. I’d hope 15k extra with only attending some number of meetings would move people, probably would me.

    #223800 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    @tim – yes, drove by in April during GC trip.  Big place.  The Music museum was a lot of fun.

    @q-school – this is where we are at current in our division.  Csuite brought in new MBAs two years ago with a 3P vision.  He left within a year and rest of the MBA infrastructure made a lot of rapid changes — all for the worse on burnout.   Rebellion started; people left/retired, got our physician leader forced resign and redesign in full swing now with — yep consultants brought in since didn’t want to return the keys to the docs to fully engage.  Let’s see how this turns out — but I swear I’ve seen this play before.

     

    Click to expand…

    I feel like this cycle happens everywhere over and over. It swings one way and then the other. Its good for docs for a while and admin sees a bunch of money on the table, they aggressively ramp up after it for a number of years resulting in dissolution of the structure that put it there in the first place, a reckoning occurs and suddenly the place is physician/patient centered, builds to good again and repeats.

    For the OP question, its not a quality measure but an engagement one, just being put under whatever definition pays for it. I think its great if it can drive engagement further. I’d hope 15k extra with only attending some number of meetings would move people, probably would me.

    Click to expand…

    yes, but once you start paying for meeting attendance, the meetings that are not paid (majority) may suffer.

    i don’t have a solution, but i know this is a very slippery slope.

    people start to argue about why someone got more meetings than someone else, especially if you are allowed to block clinic time to attend meetings that pay more than RVUs generated or especially if in a salary or shared income model.   tricky to do it right.  probably varies significantly with local culture.

    good luck to OP.

     

    #223815 Reply
    Liked by Zaphod
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2128
    Joined: 01/15/2017

    If it’s a worthy meeting to meet, then pay for it.   Whether its during the daytime or after hours, pay for it.   Harkens back to OPs post of the NYT.   meetings aren’t free…unless you’re talking about docs for some reason.

    We found it pretty funny one day that one of the main administrators complained about the 7AM meetings not during regular hours.

    #223995 Reply
    Liked by q-school, Tim
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/02/2017

    Our quality bonus is just a few bucks per wrvu, composed of

    1) willingness to recommend (press ganey), I think it’s a pretty ridiculous metric to use, for all the reasons given above.  plus there’s a lot of stuff in that metric the doc can’t control.

    2) meeting attendance (a monthly meeting, you can webex or go in person)

    3) quality metrics.  These are generally ACO metrics, and we all know how “valuable” these are.  I picked the easiest two to do – they don’t actually improve quality, they just demonstrate the ability to click buttons well.

    As there is a move towards value based care, the $/wrvu and the quality bonus per wrvu will probably change.  Yes, this will have perverse incentives. Pencil whipping is an olympic sport.

    So, I think SLC OB’s idea of a portion of bonus for engagement with meetings is a good one.  we do webex for distance purposes – if not far flung, in person is better for networking and side conversation.  I’d also consider an option to “get credit” for other activities — your process improvement guru who’s already improving things for everyone may not need to attend the meeting unless he/she is presenting, for example.

    #224056 Reply

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