The formula has been tweaked in recent years and has been spread beyond the six pilot sites to the rest of Dean's primary care system. For 2013 the package is 50% RVU-based, 30% for panel size, and up to 30% for incentives, including 10% related to medical cost control and a 20% standard package.
Albert Musa, MD, medical director for primary care, east region, for the Dean Clinic, says the reaction to the new comp plan has been well received by the primary care staff but is still a work in progress.
"You know, it actually has been good," Musa says. "Our physicians knew it was aligning them more with the right things."
But there are limits and practical challenges, he says. "When you're doing more non-RVU work and you're getting less for RVU work, you can only scale back your RVU work to a certain point." Other questions leaders found along the way include how best to balance the panel size for each physician and how to divide that care among different providers who may all care for that same complex patient. And one complication that persists is that—for all the incentives to physicians to encourage patients to use alternate means of contact, other than the office visit, "there are many patients who still want that visit, and so we can't deemphasize [the office visit] too much.
"And ultimately there is a fear that it becomes a total salary," Musa says, "A salary gives you some comfort, but I think administratively we really worry about taking away people's work ethic, too. So there's a tough balance there."
This article appears in the April 2013 issue of HealthLeaders magazine.