Encouraging physicians and providers to provide the best possible care is, partially, about having the right incentives. And today, there are a wide variety of ways to financially reward these employees for their efforts and endeavors.

Much of the decision making revolves around creating a win-win situation, where the owners of the practice, the employed providers and, most importantly, the patients benefit from the financial model and incentivization programs.

INCENTIVE MODELS

In the past, traditional models, such as a straight employment agreement with a salary, were very common; more recent modifications of this system, using base salary and bonuses based on gross collection productivity, have been very successful in incentivizing employee physicians to be efficient with their time, hardworking and motivated to see many patients and have busy practices. This structure typically works well for a general ophthalmologist or subspecialist who primarily sees insurance- or cash-paying patients with general routine exams or follow-ups for medical conditions, with some postoperative patients as well. If a provider’s role is to work alongside another provider and help with the management of pre- and postoperative patients, then many of the visits may be within global postop periods and therefore not billable by that provider. Although the doctor provides a great value to the practice and helps another big surgical-based provider, the doctor will not be able to make the threshold to enjoy the productivity-based bonus and another model must be considered that is not tied to collections.

For doctors who see a large number of patients inside postoperative care periods, especially if they were patients who had procedures performed by other doctors, it is best to move toward a straight salary position or bonus based on the number of postoperative patients seen; there can also be a direct fee paid to that provider for the number of encounters that are non-billable. This, of course, would come out of the productivity of another provider, but is often worthwhile as this would free up that provider to see a surgical consult while an associate doctor does much of the postoperative care.

THE BASICS – INCENTIVE THROUGH SENIORITY

It is quite common for associate doctors who are on a partnership track to have an increasing percentage of collections based on how long they have been in the practice and their years of service. Typically, doctors on a partnership track might start with a base salary plus a bonus of 28% to 35% of what they collect. The longer the doctor is in the practice leading up to the start of their buy-in, the higher the amount they would get to take home as a percentage of their gross collections. This structure works very well for incoming partners, because it teaches them early on that the harder they work the better they do — a desirable philosophy for future partners to embrace.

However, there are also some more creative ways to incentivize referring doctors with bonuses, one of which is based on clinical outcomes. Some practices have implemented benchmarks for clinical outcomes and patient satisfaction in wait time. Another incentive is to create bonus pools for employed physicians that reward them for quality patient care and patient experience. Flat fees per patient can be implemented, or even a pool of money that is considered bonus for leaders in the practice.

BENEFITS OF SUBSPECIALTIES

It is becoming more and more common for doctors in larger multi-specialty practices to subspecialize and find a niche within the larger group. For example, certain disease processes such as dry eye and ocular surface disease lend themselves very well towards a smaller subspecialized practice within a larger one. Along with such a practice comes the sales of over-the-counter products, such as artificial tears, hydrating face masks and ocular surface cleaning solutions. It is possible to incentivize doctors who refer patients for these in-office product purchase with a bonus-driven structure tied to the gross revenue collected in these sales.

The profits from such side entities can be split by percentages reflecting which doctors were responsible for the sales. For example, the more patients you send to the entity and the more that is spent by the patient could directly correlate with your percentage of profits you get from the entity.

Other incentives for associate doctors include the co-management of cataract and refractive patients, much like it is done with outside referring optometrists and physicians. As long as the associate doctor partakes in the care of the patient and sees the patient postoperatively with refractions and counseling time, it is appropriate to incentivize or bonus that doctor in relation to the percentage of out-of-pocket or covered medical service collections received by the primary doctor. This “fee-splitting” model, which typically follows a Medicare 80/20 split, is another form of incentivization that motivates doctors, especially general ophthalmologists, to send their patients to a subspecialist for more advanced care and to deliver excellent follow-up and continuity of care.

CONCLUSION

These are just a few of the creative strategies that can be used to incentivize associate doctors to provide outstanding quality of care to the patients within the practice. There is no “one-size-fits-all” approach, and a lot of this depends on the situation and goals of the associate doctor within the practice.

With good collaboration between the management, owner-physicians and employed physicians, a mutually beneficial arrangement can be worked out that leads to overall success for the practice, the physicians and the patients. OM

About the Author

Robert J. Weinstock, MD, is director of Cataract and Refractive Services, Eye Institute of West Florida and the Weinstock Laser Eye Center; surgical director, Largo Ambulatory Surgery Center; and associate clinical professor of ophthalmology at the University of South Florida in Tampa.