Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The problem of basing physician pay on quality indicators

Skeptical Scalpel, MD
Physician
May 1, 2013
Share
Tweet
Share

New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators.

The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients say their doctors communicated with them, rates of readmission within 30 days after discharge for heart failure and pneumonia, how quickly emergency department patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged.

The union has countered with suggestions that more indicators be used such as “going to community meetings, giving lectures, getting training during work hours, screening patients for obesity, and counseling them to stop smoking.” And they may ask that more doctors and support staff be hired.

As is typical of the doctors’ union, they had problems with the plan. They already get paid for giving lectures and training during work hours. Aren’t screening patients for obesity and counseling them to stop smoking considered part of a physician’s normal work? I do agree that doctors should receive combat or hardship pay for attending community meetings.

Another feature of the plan, which was glossed over in most secondary reports, is that the bonuses “would be given to physicians as a group at each hospital, rather than as individuals, so that even the worst doctor would benefit.” (More on this below)

The Times piece quotes officials from both sides and outside experts who offered opinions ranging from it’s a wonderful new world order to it will never work.

I tried to obtain a list of all 13 performance indicators, but it is nowhere to be found. However, looking at the ones in the Times article may be enough.

Patient assessments of how well their doctors communicated with them is going to be confounded by the fact that there are no private patients and few one-to-one doctor-patient relationships in the HHC system. Add in layers of medical students, physician assistants, residents and fellows combined with a patient population that, in many cases, suffers from a language barrier and may not even know who their doctors are, and it will be difficult to tell just who is a poor communicator.

I have discussed rates of readmission within 30 days after discharge for heart failure and pneumonia in a previous blog. This is a very poor indicator of quality and depends greatly on patient compliance with medications and instructions such as diet and activity.

How quickly emergency department (ED) patients go from triage to beds is a function of the census in the ED. This depends on many variables the MDs can’t control, such as availability of inpatient floor and ICU beds, nurse staffing, promptness in room cleaning, and many other factors.

Whether doctors get to the operating room on time is an interesting issue. As a former chairman of surgery, I have tackled this one in three different hospitals without success. First of all, what does this have to do with quality? Secondly, I truly believe that it will never be solved.

How quickly patients are discharged: Does this mean the time from admission to discharge, or is it the time from when the decision to discharge a patient is made until he actually leaves? If it’s the latter, again there are many forces at work. Does the patient want to go home? Can he get a ride? Is the bed ready at the nursing home or rehab center? If he’s being transferred by ambulance, will it arrive promptly? Is the nurse too busy to do the paperwork? Is the doctor, who may be a resident, too busy to do the paperwork?

The fact that bonuses will be tied to group, not individual, performance dooms the plan to failure. It reminds me of high school when someone threw a spitball and the teacher made everyone stay after school.

ADVERTISEMENT

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

Prev

AMA: A new initiative to improve health outcomes

May 1, 2013 Kevin 3
…
Next

Your librarian can protect you against predatory publishers

May 1, 2013 Kevin 0
…

Tagged as: Hospital-Based Medicine, Public Health & Policy, Surgery

Post navigation

< Previous Post
AMA: A new initiative to improve health outcomes
Next Post >
Your librarian can protect you against predatory publishers

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Skeptical Scalpel, MD

  • The hospital CEO who made a surgical incision. What happened?

    Skeptical Scalpel, MD
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD
  • Should speed-eating contests be banned?

    Skeptical Scalpel, MD

More in Physician

  • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

    Kayvan Haddadan, MD
  • Ethical dilemmas in using unclaimed bodies for medical research

    M. Bennet Broner, PhD
  • The Nova Oath: a physician’s pledge to courageous and ethical care

    Kenneth Ro, MD
  • True stories of doctors reclaiming their humanity in a system that challenges it

    Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO
  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When credibility is your only asset: the cautionary tale of DrKoop.com [PODCAST]

      The Podcast by KevinMD | Podcast
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
  • Recent Posts

    • When credibility is your only asset: the cautionary tale of DrKoop.com [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When credibility is your only asset: the cautionary tale of DrKoop.com [PODCAST]

      The Podcast by KevinMD | Podcast
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
  • Recent Posts

    • When credibility is your only asset: the cautionary tale of DrKoop.com [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The problem of basing physician pay on quality indicators
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...