title: How 10 leading health systems pay their doctors.
abstract: We conducted interviews with senior executives at 10 leading health systems to better understand how organizations use performance-based compensation. Of the organizations interviewed, five pay physicians using productivity-independent salaries, and five use productivity-adjusted salaries. Performance-based pay is more prevalent in primary care than in subspecialties, and the most consistently identified performance domains are quality, service, productivity, and citizenship. Most organizations have less than 10% of total compensation at risk, with payments distributed across three to five domains, each containing several metrics. Approaches with many metrics--and little at-risk compensation for each metric-may offer weak incentive to achieve any particular goal.
authors.affiliation: Massachusetts General Hospital, United States.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Khullar
authors.affiliation: Venrock Partners, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Kocher
authors.affiliation: Centers for Medicare & Medicaid Services, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Conway
authors.affiliation: Centers for Medicare & Medicaid Services, United States.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rajkumar
mesh_terms: D004526:Efficiency; D006801:Humans; D010816:Physician Incentive Plans; D010820:Physicians; D011320:Primary Health Care; D012052:Reimbursement, Incentive; D012456:Salaries and Fringe Benefits; D014481:United States
keywords: Incentives; Performance-based compensation; Productivity; Provider organization; Quality improvement; Value-based healthcare delivery