How do you incentivize practice behavior?

December 17, 2010
Richard Woodcock, MD

A significant decision regarding these standards looms over us now - how to incentivize or discourage certain behavior. There is not a right or wrong answer to this. The group needs to decide when and how hard the rubber meets the road. In our minds, our options include publication of statistics either anonymously or openly, hoping for behavior modification; escalation of punishment for failure to meet a standard, by financial or other penalties; or incentives for those performing best.

One of our practice’s great challenges seems to be deciding how to encourage or discourage certain practice behavior. For most of us, practice “standards” for certain behavior are met with mixed reviews. Many physicians, not just radiologists, feel they should be able to function autonomously. That said, there are certain aspects of the business of the practice that clearly work more effectively when everyone is on the same page. 

One example is a fair distribution of roles or shifts and overall work. Also included is an adherence to hospital contractual responsibilities, hospital or JCAHO standards, and new insurer requirements. We’ve encountered this problem over and over.

Establishing standards is a critical way to avoid internal strife in dealing with heterogeneous practice. We created a small group to review issues that might need standards. Members of the group may bring issues to them for digestion and evaluation. The small group can then filter these to decide which need input from the entire group.

At present our focus is to be strong in measurables for our clients. We are working on standards/expectations for turn-around time, and time-to-call stat results (using some of our PACS software to track). Improvement or at least satisfaction of minimum standards is a group-wide benefit and strengthens our position in talking with the hospital and our other partners.

An area we are now evaluating is adherence to PQRI standards. Since this involves a financial benefit for us all, we expect we’ll need to create a minimum compliance standard soon. Even though not everyone agrees on the importance of these, we can still find general consensus in the group on a minimum standard.

A significant decision regarding these standards looms over us now - how to incentivize or discourage certain behavior. There is not a right or wrong answer to this. The group needs to decide when and how hard the rubber meets the road. In our minds, our options include publication of statistics either anonymously or openly, hoping for behavior modification; escalation of punishment for failure to meet a standard, by financial or other penalties; or incentives for those performing best.

Currently, we are pursuing the first option. While financial incentive or pain may change behavior, it may also create animosity, so beware. These options are available not only for things like TAT, but we have also considered incentives to aid in compliance for things that may have a more subtle but positive effect on the practice’s internal and external perception, including attendance at hospital conferences (or giving them) and hospital medical staff meetings; working shifts that are less desirable (early or late hours); and administrative tasks.

In a similar vein, we have recently discussed issues related to differing opinions about lifestyle. We are exploring methods to provide incentives to those who wish to develop new avenues of business, like new interventional procedures or new teleradiology contracts. We also are looking at incentives for reading excess studies when we satisfy a minimum standard of studies read and business is busy.

By using these methods we hope to reduce internal criticism and frustration over asymmetries in work, while providing benefit to the practice as a whole.

Dr. Woodcock is a graduate of Duke University and attended the University of Virginia (UVa) School of Medicine. He completed his Diagnostic Radiology residency at UVa and completed a fellowship in Neuroradiology at Emory University. Dr. Woodcock was an Assistant Professor of Radiology in the Emory University hospital system for 8 years prior to joining Atlanta Radiology Consultants (ARC). He is currently medical director for MRI at St. Joseph's Hospital in Atlanta. He serves as a member of ARCs executive board, and is ARCs executive officer for finance. He may be reached at rjwatlrad@gmail.com.