Association between hospitalist productivity payments and high-value care culture

Reshma Gupta, Neil Steers, Chris Moriates, Michael Ong

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Given the national emphasis on affordability, healthcare systems expect that their clinicians are motivated to provide high-value care. However, some hospitalists are reimbursed with productivity bonuses and little is known about the effects of these reimbursements on the local culture of high-value care delivery. OBJECTIVE: To evaluate if hospitalist reimbursement models are associated with high-value culture in university, community, and safety-net hospitals. DESIGN, PATIENTS, AND SETTINGS: Internal medicine hospitalists from 12 hospitals across California completed a cross-sectional survey assessing their perceptions of high-value care culture within their institutions. Sites represented university, community, and safety-net centers with different performances as reflected by the Centers of Medicare and Medicaid Service’s Value-based Purchasing (VBP) scores. MEASUREMENT: Demographic characteristics and High-Value Care Culture Survey (HVCCS™) scores were evaluated using descriptive statistics, and associations were assessed through multilevel linear regression. RESULTS: Of the 255 hospitalists surveyed, 147 (57.6%) worked in university hospitals, 85 (33.3%) in community hospitals, and 23 (9.0%) in safety-net hospitals. Across all 12 sites, 166 (65.1%) hospitalists reported payment with salary or wages, and 77 (30.2%) with salary plus productivity adjustments. The mean HVCCS score was 50.2 (SD 13.6) on a 0-100 scale. Hospitalists reported lower mean HVCCS scores if they reported payment with salary plus productivity (β = −6.2, 95% CI −9.9 to −2.5) than if they reported payment with salary or wages. CONCLUSIONS: Hospitalists paid with salary plus productivity reported lower high-value care culture scores for their institutions than those paid with salary or wages. High-value care culture and clinician reimbursement schemes are potential targets of strategies for improving quality outcomes at low cost.

Original languageEnglish (US)
Pages (from-to)16-21
Number of pages6
JournalJournal of Hospital Medicine
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2019

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Hospitalists
Salaries and Fringe Benefits
Safety-net Providers
Value-Based Purchasing
Centers for Medicare and Medicaid Services (U.S.)
Community Hospital
Internal Medicine
Linear Models
Cross-Sectional Studies
Demography
Delivery of Health Care

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Association between hospitalist productivity payments and high-value care culture. / Gupta, Reshma; Steers, Neil; Moriates, Chris; Ong, Michael.

In: Journal of Hospital Medicine, Vol. 14, No. 1, 01.01.2019, p. 16-21.

Research output: Contribution to journalArticle

Gupta, Reshma ; Steers, Neil ; Moriates, Chris ; Ong, Michael. / Association between hospitalist productivity payments and high-value care culture. In: Journal of Hospital Medicine. 2019 ; Vol. 14, No. 1. pp. 16-21.
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abstract = "BACKGROUND: Given the national emphasis on affordability, healthcare systems expect that their clinicians are motivated to provide high-value care. However, some hospitalists are reimbursed with productivity bonuses and little is known about the effects of these reimbursements on the local culture of high-value care delivery. OBJECTIVE: To evaluate if hospitalist reimbursement models are associated with high-value culture in university, community, and safety-net hospitals. DESIGN, PATIENTS, AND SETTINGS: Internal medicine hospitalists from 12 hospitals across California completed a cross-sectional survey assessing their perceptions of high-value care culture within their institutions. Sites represented university, community, and safety-net centers with different performances as reflected by the Centers of Medicare and Medicaid Service’s Value-based Purchasing (VBP) scores. MEASUREMENT: Demographic characteristics and High-Value Care Culture Survey (HVCCS™) scores were evaluated using descriptive statistics, and associations were assessed through multilevel linear regression. RESULTS: Of the 255 hospitalists surveyed, 147 (57.6{\%}) worked in university hospitals, 85 (33.3{\%}) in community hospitals, and 23 (9.0{\%}) in safety-net hospitals. Across all 12 sites, 166 (65.1{\%}) hospitalists reported payment with salary or wages, and 77 (30.2{\%}) with salary plus productivity adjustments. The mean HVCCS score was 50.2 (SD 13.6) on a 0-100 scale. Hospitalists reported lower mean HVCCS scores if they reported payment with salary plus productivity (β = −6.2, 95{\%} CI −9.9 to −2.5) than if they reported payment with salary or wages. CONCLUSIONS: Hospitalists paid with salary plus productivity reported lower high-value care culture scores for their institutions than those paid with salary or wages. High-value care culture and clinician reimbursement schemes are potential targets of strategies for improving quality outcomes at low cost.",
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