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PubMed1990

The effects of positive incentive programs on physician chart completion.

It seems evident that both concurrent review programs and positive incentive programs have been implemented by a number of facilities in which little, if any, monitoring has occurred. Only half of the hospitals performing concurrent analysis provided statistics concerning the percentage of daily discharges arriving in the medical record department complete. Only one fourth of the hospitals provided information concerning the number of incomplete and delinquent medical records before and after the implementation of concurrent review. These data underscore the need for medical record administrators to evaluate the effectiveness of various strategies used to improve completion of medical records. Likewise, only a few of the hospitals that have implemented an incentive program for chart completion were able to provide all of the requested statistics concerning their chart status prior to and following the implementation of their programs. The results of the study indicate that numerous innovative procedures have been implemented in hospitals, with varying degrees of impact on the number of incomplete and delinquent medical records. The use of positive incentive programs in conjunction with punitive action is effective in helping to reduce the number of incomplete medical records.

Concurrent Review↗

PubMed1992

Medicare home health reimbursement alternatives: access, quality, and cost incentives.

This paper presents a conceptual analysis of access, quality, and cost containment incentives created by several current and potential Medicare reimbursement methodologies. The alternatives examined are methods used by health maintenance organizations (HMOs) and three options receiving national policy consideration: prospective per-visit and per-episode payment, and "bundling." The analysis found better incentives (from a policy perspective) for HMOs with integral home health units than for HMOs using outside contractors. Of the other options, per-episode payment appeared most promising, but requires accurate case mix adjustments. All approaches also require quality assurance tailored to reimbursement incentives. Topics for further research and demonstrations are suggested.

Cost Control↗

PubMed1996

Developing an incentive system for PHO physicians.

To succeed in a capitated market, a physician-hospital organization (PHO) must deliver high-quality health care in the most cost-effective manner possible. Integral to the provision of cost-effective care for patients covered by capitated contracts is the development of a sound physician incentive program. Such a system is essential to align the incentives of all the key players and enable them to share in the rewards and risks associated with capitation. Following specific guidelines for establishing physician incentive programs in a PHO can ensure the success of such programs.

Capitation Fee↗

PubMed1997

To tell the truth: disclosing the incentives and limits of managed care.

As managed care becomes more prevalent in the United States, concerns have arisen over the business practices of managed care companies. A particular concern is whether patients should be made aware of the financial incentives and treatment limits of their healthcare plan. At present, managed care organizations are not legally required to make such disclosures. However, such disclosures would be advisable for reasons of ethical fidelity, contractual clarity, and practical prudence. Physicians themselves may also have a fiduciary responsibility to discuss incentives and limits with their patients. Once the decision to disclose has been made, the managed care organization must draft a document that explains, clearly and honestly, limits of care in the plan and physician incentives that might restrict the care a patient receives.

Conflict of Interest↗

PubMed1983

How to shape incentive plans for the hospital's top executives.

Surprisingly few hospital boards use incentive payment plans for their top executives. In this article, the author provides a rationale for their use, reviews various incentive plan formats, and suggests a sample incentive contract.

Employee Incentive Plans↗

PubMed1985

Reward employees, achieve goals with incentive compensation.

Incentive compensation, rewarding employees financially for extraordinary performance, can be a motivational tool for healthcare organizations. This method of compensation uses a financial reward as an incentive for executives to achieve certain predetermined, agreed-upon goals. Incentive compensation provides two advantages for the healthcare organization--it provides a mechanism to maximize organizational productivity and it gives executives a means to achieve greater compensation.

Employee Incentive Plans↗

PubMed1986

Legal limits to physician incentives: private inurement.

For a nonprofit hospital in today's competitive climate, loss of tax-exempt status may be catastrophic. Recent rulings by the Internal Revenue Service indicate that a hospital that provides physicians with overgenerous financial incentives to recruit or maintain them on its medical staff risks just such a result. This article explores the legal doctrine of "private inurement," which prohibits charitable organizations from serving private interests, and the doctrine's application to physician incentives given by exempt hospitals. The article underscores the need for great caution in structuring the incentives and recommends that nonprofit hospitals make a practice of obtaining advance letter rulings from the Service.

Employee Incentive Plans↗

PubMed1987

Incentive pay plans boost managers' performance.

Incentive compensation, which has become commonplace in highly competitive industries, is gradually being introduced in health care settings. Although it has not been used extensively in not-for-profit hospitals, its advantages make it a natural tool for administrators who want to retain their best managers and to achieve important special objectives. Management incentives--awards based on the accomplishment of special objectives--enable boards of trustees and senior managers not only to meet difficult hospital objectives but also to attract and motivate key managers and to promote participative management and teamwork. An effective management incentive compensation program requires five support systems: strategic and operating plans; annual objectives for each manager derived from the strategic and operating plans; measureable performance standards; management action plans, which incorporate the objectives and performance standards and are used in directing each manager's efforts; and a performance evaluation system that forces tough yet reasonable evaluations. In addition to these systems, senior managers must exhibit commitment to change, and objectives must go beyond simply managing individual units well, targeting such goals as improvement of outpatient care utilization, recruitment of specialized staff physicians, and the creation of preferred provider and health maintenance organizations.

Employee Incentive Plans↗

PubMed1987

Incentive plans: has the time come?

This article provides an overview of work incentive plans and how they can affect a health care organization. The author was selected to serve on a committee responsible for developing a management incentive plan at Morton Plant Hospital in Clearwater, Florida. In doing the research associated with designing a plan, he felt that all radiology managers should become familiar with incentive systems and how they can affect their departments.

Efficiency↗

PubMed1983

Survey-based indices for nursing home quality incentive reimbursement.

Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of implementation issues.

Abstracting and Indexing↗

PubMed1988

Decree No. 96.943 on official incentives and credits for agricultural and livestock projects in the Amazon area, 12 October 1988.

This Decree suspends for a period of 90 days 1) the approval of agricultural and livestock projects in the Amazon area in places covered with tropical forests for the purpose of granting incentives related to the Brazilian Investment Fund for the Amazon; 2) the granting of official credits for livestock projects in the same areas; and 3) the granting of official incentives and credits for agricultural and livestock projects in "Mata Atlantica" in areas covered with native forests, including those in the process of regeneration. This suspension includes projects to enlarge, modernize, make technically fit, or reformulate undertakings already approved. Within the 90-day period, new criteria and rules for the granting of official credits and incentives are to be devised.

Agriculture↗

PubMed2002

Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry.

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

Administrative Personnel↗

PubMed2003

The development of prescribing incentive schemes in primary care: a longitudinal survey.

Primary Care Groups and Trusts in England (Primary Care Organisations, or PCOs) are required to operate a prescribing incentive scheme. Little is known about their development since their inception in 1999. We surveyed incentive schemes in London and the South-East NHS Regions in the two consecutive years since 1999. Most of the changes to the incentives and prescribing indicators favoured improvements in prescribing quality, rather than cost control. Quality improvements may be hampered in those PCOs offering financial rewards to underspent general practices that fail to achieve any prescribing quality targets.

Cost Control↗

PubMed2004

The new landscape: a fresh look at long-term incentives for corporate America.

Today's environment presents us with a torrent of issues surrounding the design and management of long-term and equity-related incentives, both for top executives and employees at large. This article reviews, at a conceptual level, the most important characteristics, advantages and disadvantages of the various principal long-term incentive types as they appear from key perspectives. The authors conclude with predictions about the future of long-term and equity-related incentives.

Administrative Personnel↗

PubMed2004

An incentive compensation system that rewards individual and corporate productivity.

INTRODUCTION: An economically mature health care market has led to increased cost competition. Subsequently, a perceived need for productivity-based physician compensation has developed. While some institutions have rewarded individual productivity based on specific facets of academic responsibility, such as teaching, research, and patient care, we chose to develop an incentive compensation system that rewards both individual and group productivity. PROGRAM DEVELOPMENT: We developed a physician incentive compensation system that rewards individual and group productivity by capturing multiple aspects of work activity. Faculty members are given compensation value points for clinical productivity, scholarship activities, teaching activities, service activities, and achievement of the department's goals. The system was implemented in a graduated fashion in the Department of Family Medicine at Indiana University beginning July 1, 2000. PROGRAM EVALUATION: In April 2003, all faculty physicians (n=18) participated in a survey about the compensation system. The majority of faculty view the system as a necessity for the department (72.2%); 35.2% were satisfied with the system overall; 35.3% were neutral; and 27.4% were dissatisfied or not sure of their overall satisfaction. CONCLUSIONS: A comprehensive physician incentive compensation system incorporating department goals can be designed and implemented in an academic setting.

Academic Medical Centers↗

PubMedDate not supplied

Introductory small cash incentives to promote child spacing in India.

The Ammanpettai Family Welfare Program began in 1985 as a pilot program to determine whether offering small monthly cash incentives for a limited period would be a cost-effective way to increase the use of modern temporary methods of contraception among rural Indian women who do not want to become pregnant but are not ready to adopt sterilization. The program has demonstrated that a modest cash incentive for 3-5 months attracts very large numbers of women to a clinic where they learn about and are provided with the pill, condoms, or the IUD. In catchment areas where official government reports showed temporary-methods prevalence rates of 3-5 percent at best, the Ammanpettai incentive program has attracted up to 70 percent of eligible women to join the program and try the method of their choice. By requiring that participants bring their youngest child to the clinic, the program provides for mother and child health surveillance, including immunizations. The great majority of rural women who join the program work as field laborers, have little or no schooling, and have little knowledge of or experience with modern contraceptive methods. Continuation rates are 25-50 percent at one year if follow-up is maintained by village resident women distributors. The program has been extended to several rural primary health centers in Thanjavur District, to 14 government health posts in the city of Madras, and to a semiurban area and several rural areas in Bihar. The cost-effectiveness of this program compares favorably with that of the current government family welfare program.

Adult↗

PubMed2004

Increasing adherence to a community-based guideline for acute sinusitis through education, physician profiling, and financial incentives.

OBJECTIVES: To implement a large-scale multifaceted intervention consisting of physician education, profiling, and a financial incentive, to improve treatment quality for acute sinusitis. STUDY DESIGN: Cohort trial using a historical control of treatment patterns among approximately 500 internists, 200 family practitioners, and 200 pediatricians in a northeastern community-wide individual practice association. PARTICIPANTS AND METHODS: Episode treatment group methods were adapted to identify cases (episodes) and to assess care patterns for acute sinusitis among 420,000 health maintenance organization patients seen between January 1, 1999, and December 31, 2001. The intervention consisted of care pathway development, physician and patient education, physician profiling, and a financial incentive. RESULTS: A statistical process control chart showed a shift toward recommended treatment patterns after our intervention. The rate of exceptions per episode of acute sinusitis decreased 20%, from 326 exceptions per 1000 episodes between January 1, 1999, and October 31, 2000, to 261 between November 1, 2000, and December 31, 2001. Decreased use of less effective or inappropriate antibiotics accounted for most of the change (199 to 136 exceptions per 1000 episodes [32% change]). Azithromycin use decreased 30%, from 97 to 68 prescriptions per 1000 episodes. Firstline antibiotic (amoxicillin and doxycycline) use increased 14%, from 451 to 514 prescriptions per 1000 episodes. Inappropriate radiology use decreased 20%, from 15 to 12 per 1000 episodes. These changes were significant at P < .005. CONCLUSION: A multifaceted program, including education, physician profiling with actionable recommendations, and a financial incentive, significantly increased physicians' adherence to a community-developed care pathway and was successful at improving adherence to recommended patterns of antibiotic use in acute sinusitis.

Acute Disease↗

PubMed2004

Effectiveness of financial incentives in exchange for rural and underserviced area return-of-service commitments: systematic review of the literature.

OBJECTIVE: To evaluate the effectiveness of programs that provide financial incentives to physicians in exchange for a rural or underserviced area return-of-service (ROS) commitment. METHODS: Medline and Ovid HealthSTAR databases were searched from 1966 to 2002. STUDY SELECTION: The initial search yielded 516 results. Bibliography review yielded additional references. Articles were excluded if they involved financial incentives to change physician behaviours or enhance profit. Ten publications were selected as the highest level of evidence available. The quality of the evidence was low and of limited applicability (1 retrospective and 1 prospective cohort study, the remainder cross-sectional surveys). Three studies were from Canada, 1 from New Zealand, and the remaining 6 were from the United States. RESULTS: Outcome measures included initial recruitment of physicians, buyout rates and long-term retention. The majority of studies reported effective recruitment despite high buyout rates in some US-based programs. Increasing Canadian tuition and debt among medical students may make these programs attractive. The 1 prospective cohort study on retention showed that physicians who chose voluntarily to go to a rural area were far more likely to stay long term than those who located there as an ROS commitment. Multidimensional programs appeared to be more successful than those relying on financial incentives alone. CONCLUSION: ROS programs to rural and underserviced areas have achieved their primary goal of short-term recruitment but have had less success with long-term retention. Additional research is needed to examine the cost effectiveness of existing ROS programs and the incorporation of other retention strategies, such as medical education initiatives, community and professional support, differential rural fees and alternate funding models.

Canada↗