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Great question, and nice response by Crazybird. I especially like the idea of asking the employee to suggest the best goals and measurement methodology up front. It may not be exactly what you go with, but having their input early is important.

One major caveat: whatever you incentivize is what will be focused on, often at the peril of everything else. I have had providers that were incented to see more patients…and they did…to excess. Volume increased by 50%. But everyone was miserable…the provider, the staff and the patients. We are still trying to figure out a way to put that genie back in the bottle.

For these upper level employees, the incentives should be specific to each one. Every aspect of what you hope that employee accomplishes needs to be considered with an incentive. For example, if a clinician is incented to see more patients, they may do so at the expense of administrative responsibilities, research and even the quality of care provided. Patient satisfaction scores may go down if the provider seems rushed, and staff may become burned out due to an increase of volume. While you can’t control for every variable, the incentive should include a baseline level of performance for all areas, before excelling in one area is bonused. For example, the provider will be bonused for seeing more patients, but only if patient satisfaction scores or quality indicators remain stable.

Often, the challenge is not getting results quickly, it is translating those results in a meaningful way to the patient. A “normal” result is clear, but many times, what an imaging report or a lab result communicates to the patient can be confusing and cause more anxiety. In my world, I am often communicating imaging results of the spine. The MRI report may show pages of degenerative changes, that mean very little clinically. It takes a clinician to review the imaging, understanding the context of the patient’s symptoms, to determine what is relevant on the MRI. I don’t actually like when the patient sees a report before I can discuss this with them. There is actual literature that shows low back pain patients have worse outcomes when they know their MRI results.

So, what has been helpful is up front education, before the test is even obtained. I spend a lot of time when ordering the MRI, explaining to the patient that I expect to see multiple degenerative changes, and that this is normal. Now, as soon as the MRI is complete, I review the images, and unless there is something concerning, my nurse will call with results. The turn-around time is pretty quick, and I have prevented the typical concern/anxiety about the “severe degenerative disc disease” that is written on the patient’s MRI report.

Hi Tom. We struggle with the same issue in our system. I am not sure this would translate to the Netherlands, but in our practice we offer a very strong benefits package. Our salary is comparable to the rest of the market, but our benefits are better. We fund their entire health care plan (again, may not apply to you) and offer a profit-sharing plan (like a pension). These days, when staff will change jobs for a $.25/hour raise, most have found that our benefits offer much greater overall value.

Hi Nicola. Congratulations on the success you have already seen. On a smaller scale, my practice has faced very similar challenges. We have grown from 4 docs in one clinic with 20 employees, to 16 providers, 75 employees, 3 clinic locations, an ASC and an MRI. We used to have a very tight knit staff who were committed to our vision. As we have grown we have dealt with all of the challenges you list. We continue to struggle with these exact issues, so I don’t think there is one clear solution. But one recent change we have made has been helpful. Because our employees are spread out geographically, there are some that we (physicians/owners) never see. It is hard for them to understand our vision and be vested in our practice. We have started to bring everyone together on occasion. It is difficult, because this means all clinical care stops for a short period of time (it was hard for some owners to swallow the idea that the MRI would not be running for 1 hour!), and we really don’t have a good space to bring this many employees together. So we basically close the clinic and get together in the waiting room. It seemed a bit awkward at first, but the feedback has been outstanding…well worth the 1 hour of productivity “lost”.

Hi Aldo. We have found this VERY challenging in our system. Even pricing for relative “commodity” services like labs and imaging are difficult to publish, as the “price” will vary based on the patient’s insurance contract. The “cost” of a specific MRI for a medicare patient may be $300, for private insurance X, it is $500 and for private insurance Y, it is $800. So we cannot just list prices as is done in other markets that don’t have an insurance company between the provider and the consumer.

We have started to at least communicate the cost directly to each patient, depending on their insurance. This ends up being one-to-one communication that doesn’t fit with marketing strategies in most industries. Then it is up to the patient to shop around based on their insurance plan. Clearly this is more onerous to the patient, than being able to pull up a website to compare costs, but in our system where we cannot share contract information with other providers, it seems like the best we can do currently. I am looking forward to hearing other responses to your dilemma.