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David Taylor
Vice President, Regional Services
Cox Health
Springfield, MO

David Taylor has worked for 22 years in integrated delivery systems, including the past nine at Cox Health, a three-hospital IDS in Springfield, MO. With physician employment back in vogue, many hospitals and health systems are struggling with developing successful physician compensation strategies. Taylor has been through those battles.

Taylor: We employ about 160 physicians and another 40–50 physician extenders. We also have a close arrangement with another large medical group consisting of about 115 physicians. Our employed group has 60 locations.

The compensation program all of our primary care physicians are on is a professional collections model. That means it's managed like a private practice where expenses are charged back to the practice. The more they collect, the more opportunities they have for income. We provide investment in the practice and financial support for the primary care groups. We have some other plans, like with our hospitalists, where we pay on work RVUs so it's production driven.

That's been a real plus because it incentivizes production and takes payer mix out of the equation. A small percent (5%–6%) of work RVUs gets put into a pool of incentives based on customer satisfaction rates, quality indicators, attendance at meetings, and getting records done. There may be a day where we can incorporate that into primary care, but not immediately. They're satisfied with the plan we have.

I've been one place where physicians were salaried and with that, there's no incentive to see any more patients. I was also at an organization where we paid a straight percentage of collections. That means there's no accountability on the expense side. This is the best of both worlds.

Philip Betbeze

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