Association between Hospitalist Productivity Payments and High-Value Care Culture
BACKGROUND: Given the national emphasis on affordability, healthcare systems expect that their clinicians are motivated to provide high-value care. However, some hospitalists are reimbursed with productivity bonuses and little is known about the effects of these reimbursements on the local culture of high-value care delivery.
OBJECTIVE: To evaluate if hospitalist reimbursement models are associated with high-value culture in university, community, and safety-net hospitals.
DESIGN, PATIENTS, AND SETTINGS: Internal medicine hospitalists from 12 hospitals across California completed a cross-sectional survey assessing their perceptions of high-value care culture within their institutions. Sites represented university, community, and safety-net centers with different performances as reflected by the Centers of Medicare and Medicaid Service’s Value-based Purchasing (VBP) scores.
MEASUREMENT: Demographic characteristics and High-Value Care Culture Survey (HVCCSTM) scores were evaluated using descriptive statistics, and associations were assessed through multilevel linear regression.
RESULTS: Of the 255 hospitalists surveyed, 147 (57.6%) worked in university hospitals, 85 (33.3%) in community hospitals, and 23 (9.0%) in safety-net hospitals. Across all 12 sites, 166 (65.1%) hospitalists reported payment with salary or wages, and 77 (30.2%) with salary plus productivity adjustments. The mean HVCCS score was 50.2 (SD 13.6) on a 0-100 scale. Hospitalists reported lower mean HVCCS scores if they reported payment with salary plus productivity (β = −6.2, 95% CI −9.9 to −2.5) than if they reported payment with salary or wages.
CONCLUSIONS: Hospitalists paid with salary plus productivity reported lower high-value care culture scores for their institutions than those paid with salary or wages. High-value care culture and clinician reimbursement schemes are potential targets of strategies for improving quality outcomes at low cost.
© 2019 Society of Hospital Medicine
CONCLUSION
The HVCCS can identify clear targets for improvement and has been evaluated among internal medicine hospitalists. Hospitalists who are paid partly based on productivity reported low measures of high-value care culture at their institutions. As the nation moves toward increasingly value-based payment models, hospitals can strive to improve their understanding of their individual culture for value and begin addressing gaps.
Acknowledgments
The authors wish to thank Michael Lazarus, MD from the University of California Los Angeles; Robert Wachter, MD, James Harrison, PhD; Victoria Valencia, MPH from Dell Medical School at the University of Texas at Austin; Mithu Molla, MD from University of California Davis; Gregory Seymann, MD from the University of California San Diego; Bindu Swaroop, MD and Alpesh Amin, MD from University of California Irvine; Jessica Murphy, DO and Danny Sam, MD from Kaiser Permanente Santa Clara; Thomas Baudendistel, MD and Rajeeva Ranga, MD from Kaiser Permanente Oakland; Yile Ding, MD from California Pacific Medical Center; Soma Wali, MD from Los Angeles County/ OliveView UCLA Medical Center; Anshu Abhat, MD, MPH from the LA BioMed Institute at Los Angeles County/ Harbor-UCLA Medical Center; Steve Tringali, MD from Community Regional Medical Center Fresno; and Dan Dworsky, MD from Scripps Green Hospital for their site leadership and participation with the study.
Disclosures
Dr. Gupta is the Director of the Teaching Value in Healthcare Learning Network at Costs of Care. Dr. Moriates receives royalties from McGraw Hill for the textbook “Understanding Value-based Healthcare” outside of the submitted work and is the Director of Implementation at Costs of Care.
