Practice Management

Productivity-based salary structure not associated with value-based culture


Background: Although new payment models have been implemented by the Centers for Medicare & Medicaid Services (CMS) for hospital reimbursement, little is known about the effects of reimbursement models on the culture of providing value-based care among individual hospitalists. The concern is that productivity-based models increase pressure on hospitalists to maximize volume and billing, as opposed to focusing on value.

Study design: Observational, cross-sectional, survey-based study.

Setting: A total of 12 hospitals in California, which represented university, community, and safety-net settings.

Synopsis: Hospitalists were asked to complete the High-Value Care Culture Survey (HVCCS), a validated tool that assesses value-based decision making. Components of the survey assessed leadership and health system messaging, data transparency and access, comfort with cost conversations, and blame-free environments. Hospitalists were also asked to self-report their reimbursement structure: salary alone, salary plus productivity, or salary plus value-based adjustments.

A total of 255 hospitalists completed the survey. The mean HVCCS score was 50.2 on a 0-100 scale. Hospitalists who reported reimbursement with salary plus productivity adjustments had a lower mean HVCCS score (beta = –6.2; 95% confidence interval, –9.9 to –2.5) when compared with hospitalists paid with salary alone. An association was not found between HVCCS score and reimbursement with salary plus value-based adjustments when compared with salary alone, though this finding may have been limited by sample size.

Bottom line: A hospitalist reimbursement model of salary plus productivity was associated with lower measures of value-based care culture.

Citation: Gupta R et al. Association between hospitalist productivity payments and high-value care culture. J Hosp Med. 2019;14(1):16-21.

Dr. Huang is a physician adviser and associate clinical professor in the division of hospital medicine at the University of California, San Diego.

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