Physician Performance Reviews Explained

Physician Performance Reviews Explained.
As medical payment moves from fee-for-service to value-based care and as more than half of doctors are now employees of hospital systems, private equity firms, health insurance companies or retailers like Amazon... Performance Reviews of doctors become increasingly important.
Physician Performance Reviews Range from...
Academic Medical Centers: Structured annual processes measuring amount of work done in RVUs, patient and medical student reviews, clinical outcomes such as blood pressure and A1c control in patients... even handwashing and meeting attendance.
to
Community Hospitals: Annual review of metrics including patient length-of-stay, chart reviews, nursing feedback... even time it takes to call back the ER.
to
Private Practice: Non-partner doctors have productivity requirements and semiannual meetings with partner physicians and partner physicians themselves often have no performance review.
Doctors may benefit from a more stringent performance review process akin to other professions dealing with life and death matters such as the US Military.
Sources:
www.jointcommission.org/stand...
usacac.army.mil/sites/default...\
/ implementing-employee-...
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[@michaeltabet9223]

This channel is A-mazing

[@ahealthcarez]

Thank you for your kind feedback.

[@bigpicturemedicine]

Thanks for another awesome video. I think many Physicians are wary of performance reviews because of the perverse incentives these can create. This of course is not a unique issue to clinical medicine (and there are ways around it) - but the stakes are much higher. I remember an ED which would closely monitor how many new patients each Physician saw during a shift. This led to the following behaviours (all of which led to poor care): - Intentionally picking up 'easy' patients and avoiding complex cases - Premature referrals/admits to minimise time per patient - Avoiding handovers from colleagues (these patients would not be counted on your tally) - Generally not being helpful to colleagues/other specialties Maybe hubris, but being a good Physician seems to involve so many intangibles which don't always fit OKRs (empathy, teaching, going above and beyond). The standard I've seen in a UK context is specifying a minimum competence for all Physicians (are they safe?) and avoiding tying pay to specific measurables (at least on an individual level). My sceptical take is that pay incentives in the US context are ultimately tied to billable activity and lead to worse care. Although happy to be challenged on this!

[@ahealthcarez]

Thank you for your thoughtful comment.

[@larzfish]

Thanks for these great videos. I will say it is humorous though that you finish up with military performance reviews. I would say that as a military physician that is one of the most maligned aspects of our services. Our current process does not include any aspect of clinical performance in their annual review. Instead we spend most of our time hand-waving about peperceived leadership qualities.

[@ahealthcarez]

Understood. Thank you for your feedback.

[@matthewherman5608]

I would say that in the future we should have performance reviews but not based on RVU's. I think RVUs are a perverse incentive. For example, rheumatology is probably not pulling in a lot of RVUs but I would contend that them and the immunologists, also I think who don't pull in a lot of RVUs for the hospital, do very important work.

[@ahealthcarez]

Agreed. Thank you for watching.

[@Plan_Jey]

Who would be conducting the performance reviews? This is a really fascinating topic.

[@ahealthcarez]

Good question. They are performed by the boss doctors.

[@Koru-Health]

Would you consider a video on ACO's / value-based care, there current relevance and projected future?

[@ahealthcarez]

Sure. Thank you for your suggestion.

[@christophermoriarty7843]

Should employed physicians on productivity get cost-of-living insurance increases? I had this thought the other day when I realized the only way for my salary to keep up with inflation is for me to see more patient/do more procedures every single year for the rest of my employment.

[@ahealthcarez]

Yes. Some physicians do.

[@Koru-Health]

Do you bill the payor's (insurance) directly as part of a physician group or are you contracting with an organization (HCA etc.) who is billing insurance and compensating you on other metrics (productivity, etc.)? The circumstance impacts the answer. Both can be negotiated either directly with insurance payors or contract settings.

[@matthewherman5608]

I like that investment bankers have rebranded themselves as "private equity" after the great recession of 2008 *(obvious sarcasm)*

[@ahealthcarez]

Thank you for sharing your thoughts.