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Experiential Exercises Mapleton Family Medicine is a physician group practice lesated in a small city (population 150,000) in set 30 patients per day as a base and, through the incentive system, encourage physicians to see, on average, up to 35 patients per day Case he Midwest. Mapleton is an cight-physician practice consisting of family physicians, inter considered three measures: nists, and pediatricians. The practice is owned In terms of quality, the owners have two of the physicians; the other six physicians 1. Patient satisfaction surveys are salaried. The owners are concerned with 2. Child immunization audit data productivity and quality in the practice. The 3. Patient waiting times waiting time for appointments is relatively long and a recent chart review revealed that the per Quality goals will be set biannually for each centage of children who are up-to-date with physician. The expectation is that physicians immunizations has dropped. Also, anecdotal who achieve these goals will earn their full evidence suggests that at-risk persons are not salary (assuming volume is adequate), and routinely recciving flu and pneumonia vaccina quality measures above these goals will result tions. Many patients have complained about in bonuses according to a pay schedule having to wait up to 90 minutes in the waiting room. At this time, however, the practice is not Case Questions in a position to hire another physician 1. You have been brought in to advise compensation plan. What advice 2. Do you see any potential negative Each physician in the practice sees an The owners the owners on their proposed avcrage of 25 patients per day. want this number increased to 30 per day without sacrificing quality of care. To reach this goal, they are thinking of moving to an incentive system whereby physicians have a base salary equivalent to 75 percent of their current salary and have the opportunity 3. How do you think the physicians in the to earn up to 125 percent of their base sal- ary if they meet defined volume and quality they be involved in developing the plan, goals. While the owners have not completelyand if so, how should they be involved thought this system through, they want to patientsyou give them before they proceed? consequences of this plan based on the information provided? If so, how will you address these concerns? practice will react to this plan? Should

Answer 1

1).

The two compensation plans used by the Mapleton Family Medicine practice are, quality-focused, and productivity-focused pay for performance incentives. In the case of pay for performance that focuses on productivity, the profitability of an organization is to be improved by combining the financial incentives and individual employee productivity.

In the case of pay for performance that focuses on quality, the healthcare outcomes are improved by including the programs reward activities and practices. It also includes the prevention strategies, up-to-date patient vaccinations, reducing the medical errors, and adhering to the evidence-based medical practices.

In this case, the owners are expecting improved productivity in which more patients are visiting the physician per day, and the improvement in quality are expected in multiple areas, i.e. patient satisfaction, compliance in immunization, and reducing the wait time for appointments. In order to achieve this, they need to include incentives to each of the areas (piece-rate incentives) instead of providing incentives as a whole. This help in improving the physicians focus on all areas, so the overall improvement in the expected areas can be achieved.