Physician compensation programs in academic medical centers

Many academic health centers are creating incentive-based physician compensation programs, leading to skepticism regarding the impact on the academic mission. We sought to systematically review the impact of these programs. Most academic compensation programs demonstrate a positive impact on clinical and scholarly productivity, quality of education, and faculty satisfaction.     

Physician incentive compensation in group practice: a review with suggestions for improvement

Without a well-developed compensation plan, not only will medical groups fail to address their responsibility for minimizing health care cost inflation, but they may also experience dissension, resignations, inability to attract new practitioners and varying levels of output among the group members.     

Physician use of disease management programs.

This paper examines differences in availability, use, and perceived usefulness of disease management programs as reported by generalist and specialist physicians functioning as primary care providers in health plans. Implications of these differences are discussed in terms of the three types of purchasers: private insurers, Medicare, and Medicaid. The design is a cross-sectional mail and telephone mixed-mode survey. The data come from 23 health plans in five states (Florida, New York, Colorado, Pennsylvania, and Washington), including six metropolitan areas: Seattle, New York City, Miami, Pittsburgh, Philadelphia, and Denver. The study participants are 1,244 generalist and specialist physicians who contracted with health plans as primary care providers. They were drawn from a 2001 mail and telephone survey of 2,105 generalist and 1,693 specialist physicians serving commercial, Medicaid, and Medicare patients. Physician responses about use of disease management for their patients in the health plan and how useful they thought it was were regressed on physician, physician organization, and physician-health plan relationship characteristics. While generalist physicians are likely to report having disease management programs available and using them, specialists vary greatly in their response to the disease management programs. In contrast to physicians associated with commercial plans, implementation of disease management programs among physicians associated with Medicaid plans varied across states. Primary care providers trained in generalist areas of practice are more likely than specialists functioning as primary care providers to report that disease management programs are available and to use them. They also find them more useful than do specialists.     

Physician compensation models in medical group practice

This article examines physician compensation models in medical groups and the factors affecting physician compensation and their impact on individual physician behavior and group practice performance. Four categories of physician compensation models are identified: (1) production-based compensation, (2) salary, (3) group-based compensation unrelated to individual physician productivity, and (4) capitation-based compensation. The statistics and the economic incentives of different compensation methods are presented. Finally, the impacts on health resources consumption, charges in medical group procedures for utilization and care management, and quality of care are discussed.     

Vaccine injury compensation programs worldwide

Approximately a dozen countries provide some form of compensation for injuries (or deaths) following vaccination. More than anything else, they were instituted in the belief governments have a special responsibility to those injured by properly manufactured and administered vaccines used in public health programs. Administratively, most are managed through the national government, including decisions on eligibility for and amount of compensation. Eligibility may depend on the recipient's age, citizenship or residency status, category of vaccine (e.g., recommended, compulsory), the location it is administered (public vs private ambulatory setting), or satisfying certain time frames for filing a claim. Since few vaccine-related injuries have a clinical or laboratory marker, proving actual causation is difficult. Causation decisions are usually based on the balance of probabilities standard of more likely than not. All countries require that the effects be long lasting (e.g., greater than 6 months), and nearly all provide coverage for medical costs, disability pensions, and death benefits, while noneconomic damages (pain and suffering) are included much less frequently. Funding is generally from the national treasury, with some programs receiving support from lower governmental entities or vaccine manufacturers. After nearly 4 decades of operation, vaccine injury compensation program appears to be an increasingly accepted component of immunization programs today. While we have a much better understanding of their statutory purpose, frame work, process and outcome, there is much more to be learned. Future research should focus on vaccine compensation programs and (1) decision-making at the administrative level; (2) the utilization of outcome indicators in order to gauge effectiveness, including immunization acceptance; (3) the knowledge and attitudes of the public and medical community in host countries; and (4) the overall perspective of vaccine manufacturers. Insight into these and other areas will no doubt aid other countries as they consider implementing programs of their own.     

Physician cost experience under private health insurance programs

Little information is available on private payer claims cost experience for specific categories of health care. A study was conducted in which physician-claims cost experience and trends among 15 Blue Cross and Blue Shield Plans were compared. Between 1986 and 1988, physician claims cost per covered person increased at an average annual rate of 17 percent, approximately 6 percentage points higher than for Medicare. Annual charges were highest for laboratory (24 percent), radiology (19 percent), and medical care (18 percent) services. Utilization trends were also examined in the study. The number of radiology imaging procedures performed increased 48 percent between 1986 and 1988, and the number of hospital visits declined by 6 percent.     

Merit pay and incentive compensation systems for physicians and managers

In Russia, as in all countries, physicians are and will continue to be central actors in health sector reform and in health sector resource allocation decisions. How they are recognized and rewarded for their work will therefore dramatically influence the ultimate success of reforms and health sector expenditure patterns. Much of the debate in Russia and many of the articles in this special edition of the Journal are focused on creative ways to move money from purchasers to provider institutions. There has not been enough discussion nor analysis of how money needs to move within institutions to individual physicians and managers as a means to influence their behavior. A new approach to base and merit pay is needed. This article explores conceptual and practical dimensions of alternate ways to compensate physicians as clinicians and managers. New forms of recognition and types of rewards will be summarized. Managerial skills and systems needed to support such new methods will also be highlighted.