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Book part
Publication date: 20 March 2007

Chalmer E. Labig and Kenneth Zantow

Managed care organizations use physician incentives to control costs and ensure their financial viability. While the efficacy of incentives may be questioned, substantial…

Abstract

Managed care organizations use physician incentives to control costs and ensure their financial viability. While the efficacy of incentives may be questioned, substantial challenges exist for physicians who must balance the well-being of their patients and the focus of their professional training with organizational financial concerns. Many physicians experience difficulty in discussing incentive pay with patients (Pearson & Hyams, 2002), even though patients want to know (Pereira & Pearson, 2001) and tend to trust physicians more who are forthright about the issue (Levinson, Kao, Kuby, & Thisted, 2005). Of interest here are patients’ perceptions of the ethicalness of commonly used physician pay incentives. The results of our findings suggest that patients may view these incentives from a different perspective than health policy experts and physician executives. Specifically, our findings indicate that patients perceive incentives based upon patient satisfaction and clinical efficiency more ethically than incentives based upon revenue generation. These views are significantly related to physician visits. We offer suggestions for future research in light of recent pay disclosure regulations.

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Insurance Ethics for a More Ethical World
Type: Book
ISBN: 978-1-84950-431-7

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Book part
Publication date: 4 October 2012

Genna R. Cohen, Natalie Erb and Christy Harris Lemak

Purpose – To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate…

Abstract

Purpose – To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate incentive program goals into their specific office setting. Understanding how new financial incentives fit with the structure of physician practices and individual providers’ work may shed some insight on the variable effects of physician incentives documented in numerous reviews and meta-analyses.

Design/Methodology/Approach – Reviewing select articles on pay-for-performance evaluations to identify and characterize the presence of implementation mechanisms for designing, communicating, implementing, and maintaining financial incentive programs as well as recognizing participants’ success and effects on patient care.

Findings – Although uncommonly included in evaluations, evidence from 26 articles reveals financial incentive program sponsors and participants utilized a variety of strategies to facilitate communication about program goals and intentions, to provide feedback about participants’ progress, and to assist practices in providing recommended services. Despite diversity in programs’ geographic locations, clinical targets, scope, and market context, sponsors and participants deployed common strategies. While these methods largely pertained to communication between program sponsors and participants and the provision of information about performance through reports and registries, they also included other activities such as efforts to engage patients and ways to change staff roles.

Limitations – This review covers a limited body of research to develop a conceptual framework for future research; it did not exhaustively search for new articles and cannot definitively link particular implementation mechanisms to outcomes.

Practical Implications – Our results underscore the effects implementation mechanisms may have on how practices incorporate new programs into existing systems of care which implicates both the potential rewards from small changes as well as the resources which may be required to obtain buy-in and support.

Originality/Value – We identify gaps in previous research regarding actual changes occurring in physician practices in response to physician incentive programs. We offer suggestions for future evaluation by proposing a framework for understanding implementation. Our model will assist future scholars in translating site-specific experiences with incentive programs into more broadly relevant guidance for practices by facilitating comparisons across seemingly disparate programs.

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Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems
Type: Book
ISBN: 978-1-78190-191-5

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Article
Publication date: 1 February 1995

Karl McCleary, Patrick Asubonteng and George Munchus

Examines the relationship between the presence of financialincentives and their effect on physician behaviour in health maintenanceorganizations (HMOs). By reviewing the…

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Abstract

Examines the relationship between the presence of financial incentives and their effect on physician behaviour in health maintenance organizations (HMOs). By reviewing the scope and dimensions of both HMOs and financial incentives, a foundation is laid for the review of the current empirical evidence. Further analysis and conceptual development is given to this topic by stating the limitations of existing research – in the confounding variables, in the complexity of incentives, and in the unanswered questions of quality of care – and by proposing innovative ways of studying the “other aspects of physician behaviour” not previously considered. Questions and implications are raised for future research and practice.

Details

Journal of Management in Medicine, vol. 9 no. 1
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 1 July 2018

Saligrama Agnihothri and Raghav Agnihothri

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Abstract

Purpose

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Design/methodology/approach

Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.

Findings

This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.

Originality/value

This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.

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Book part
Publication date: 10 December 2005

John H. Evans, Andrew Leone and Nandu J. Nagarajan

This study examines the economic consequences of non-financial measures of performance in contracts between health maintenance organizations (HMOs) and primary care…

Abstract

This study examines the economic consequences of non-financial measures of performance in contracts between health maintenance organizations (HMOs) and primary care physicians (PCPs). HMOs have expanded contractual arrangements to give physicians not only financial incentives to control costs, but also to make the physicians accountable for the quality of patient care. Specifically, we examine how quality provisions in HMO–PCP contracts affect utilization (patient length of stay in the hospital), patient satisfaction, and HMO costs. Our results show that quality clauses are associated with a statistically significant increase in utilization (29 more hospital days annually per 1,000 HMO enrollees). Further, inclusion of quality clauses in PCP contracts also led to a significant increase in patient satisfaction, but no associated increase in HMO costs. Overall, these results suggest that quality clauses in PCP contracts can increase value by increasing customer satisfaction without significantly increasing cost.

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Advances in Management Accounting
Type: Book
ISBN: 978-0-76231-243-6

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Article
Publication date: 2 May 2008

Joseph S. Guarisco and Stefoni A. Bavin

The purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables…

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1408

Abstract

Purpose

The purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.

Design/methodology/approach

The case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.

Findings

The findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.

Practical implications

These findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.

Originality/value

There are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

Details

Leadership in Health Services, vol. 21 no. 2
Type: Research Article
ISSN: 1751-1879

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Book part
Publication date: 11 August 2014

Mona Al-Amin, Robert Weech-Maldonado and Rohit Pradhan

The hospital–physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals’ ability to achieve socially and…

Abstract

Purpose

The hospital–physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals’ ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs.

Design/methodology approach

We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs.

Findings

We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency.

Research limitations

There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted.

Research implications

While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model.

Practical implications

Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment.

Originality/value

This is the first chapter to explore an alternative hospital–physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

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Article
Publication date: 2 February 2021

Sofie Vengberg, Mio Fredriksson, Bo Burström, Kristina Burström and Ulrika Winblad

Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper…

Abstract

Purpose

Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work.

Design/methodology/approach

An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system.

Findings

Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses.

Practical implications

Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers.

Originality/value

This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.

Details

Journal of Health Organization and Management, vol. 35 no. 4
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 26 August 2010

Katharina Janus

Human resources management (HRM) has evolved from primarily focusing on monetary incentives toward incorporating other nonmonetary aspects for managing professionals…

Abstract

Human resources management (HRM) has evolved from primarily focusing on monetary incentives toward incorporating other nonmonetary aspects for managing professionals’ motivation. However, in health care organizations, paying professionals for performance persists although evidence for its return on investment is scant. This raises the question whether monetary incentives are, in fact, the (only) motivator for health care professionals or whether other incentives could substitute or complement them in the future. This chapter reviews the basic ideas of pay for performance (P4P) and its current challenges. Taking into account HRM's experience (and evolution) in other industries, I discuss the interdependence and the impact of extrinsic and intrinsic motivators in health care. On the basis of the health care market's standing as a knowledge-intensive industry in which multiple actors contribute their knowledge to multiple tasks, I will offer suggestions how to manage motivation based on individuals’ intrinsic needs instead of relying solely on extrinsic motivators.

Details

Strategic Human Resource Management in Health Care
Type: Book
ISBN: 978-1-84950-948-0

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Book part
Publication date: 11 August 2014

Lawton Robert Burns, Jeff C. Goldsmith and Aditi Sen

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of…

Abstract

Purpose

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

Design/Methodology Approach

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

Findings

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

Research Limitations

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Research Implications

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Practical Implications

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

Originality/Value

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Keywords

1 – 10 of over 3000