Creative Compensation for Hospitalists John Nelson, MD Principal, Nelson Flores Hospital Medicine Consultants Medical Director, Hospitalist Practice Overlake Hospital, Bellevue, WA [email protected] (425) 467-3316
Creative Compensation for Hospitalists
John Nelson, MDPrincipal, Nelson Flores Hospital Medicine Consultants
Medical Director, Hospitalist PracticeOverlake Hospital, Bellevue, WA
[email protected](425) 467-3316
Part 1:the amount of compensation…
Compensation*
*Non-academic hospitalists caring for adults; includes bonuses
$246,000
$213,000$224,000
$212,000
N=726
~3% increase over prior year
1,745 enc3,892 wRVUs
1,928 enc3,858 wRVUs 2,297 enc
4,092 wRVUs
2,747 enc4,931 wRVUs
Annual Productivity per FTE
enc = billable encounters
Minimal change from prior year
*Compensation per wRVU
$55$56
$52
$54
Juice to Squeeze Ratio*
Compensation as a Function of Productivity
Comp per wRVU
Less productive hospitalists
More productive hospitalists
Part 2:The method of compensation
Mix salary components as you see fit
Mix salary components as you see fit
My bias:•Largest component based on production
•Significant performance (quality) component (at least 15 – 10% of total comp)
•Small (or 0) fixed component (instead put in place a 1 or 2 yr. minimum salary guarantee for new docs)
Reasons hospitalists are averse to significant production compensation
The Fear An alternative viewCan’t control daily patient volume Reasonably precise control of
workload/compensation over long period of time by managing staffing levels
Will disrupt cohesive culture - will lead to competing with one another for the next patient
Makes it much easier to trade work between group members – promotes cohesion
It is just a way to get hospitalists to work unreasonably hard, leading to poor patient care and burnout
It provides each doctor some flexibility to make individual choices about how hard he/she wants to work
Will lead to increased LOS, since hospitalists can increase income by keeping pts in hospital longer
A legitimate concern, but not likely to happen unless the practice is overstaffed
Will adversely affect recruiting It will unless you can explain to recruits why the hospitalists believe it is a good thing
Quality incentive• Use metrics you’re already measuring• Rotate metrics (annually?)• Compensate on a sliding scale rather than all
or none• Most quality metrics lend themselves to group
(vs. individual) payment• Not worth implementing if too easy/difficult
to achieve
ReferencesResults of SHM 2008 survey of incentive compensation and discussion of designing a quality incentive:http://www.the-hospitalist.org/details/article/184556/Bonus-Pay_Bonanza.html
Meeting on November 4, 2011, in Las Vegas on implications of the adoption of the hospitalist model of practice by many specialties in medicine:http://www.hospitalmedicine.org/Content/NavigationMenu/Events/HospitalFocusedPractice/home.htm