Improving clinical productivity in the academic setting: a novel incentive plan based on utility theory.
OBJECTIVE
Academic internal medicine practices face growing challenges to financial viability due to high overhead, competing institutional missions, and suboptimal physician productivity. The authors describe the development of a clinical incentive plan for a group of academic subspecialty physicians at the Dana Clinic, an outpatient setting at Yale School of Medicine, and report on results of the first year's experience under the plan.


METHODS
Utility theory was used to assess the risk profile of clinic faculty and identify incentive payments that would optimize faculty benefit or "utility" while minimizing departmental costs. Under the plan, physicians who reached a productivity target based on work Relative Value Units (wRVUs) between October 2003 and November 2004 had overhead costs covered and received a fixed payment to support salary; additional incentive payments were available for those exceeding the target. Physicians failing to reach the target were responsible for their own overhead costs and received no fixed payment. Physician productivity as measured by wRVU per full-time equivalent (FTE) was compared for the year prior to, and the year following, incentive plan introduction.


RESULTS
Forty-seven members of eight academic sections were included in the analysis. Median productivity improved by 34%, with 42 of 47 physicians showing improvement. Significant improvements were also noted in collections (62%) and visit volume (23%), and shifts were observed in coding patterns.


CONCLUSIONS
The unique threshold-based structure of the incentive plan, as determined through utility theory modeling, as well as permitting physicians to choose how to achieve the wRVU target were key features of its success, resulting in improved productivity without increasing practice resources or faculty salaries.
Wilson
Madeline S
MS
Yale Internal Medicine Associates, Yale School of Medicine, 789 Howard Ave, Dana 3, New Haven, CT 06510, USA. madeline.wilson@yale.edu
Joiner
Keith A
KA
Inzucchi
Silvio E
SE
Mulligan
Gary J
GJ
Mechem
Mary F
MF
Gross
Cary P
CP
Coleman
David L
DL
D003365:Costs and Cost Analysis; D004467:Economics; D004470:Economics, Medical; D006801:Humans; D010816:Physician Incentive Plans; D010820:Physicians / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012308:Risk Management; D012577:Schools, Medical; D013038:Specialization