Special report: Enlisting workers in the value-based purchasing effort
More hospitals offer frontline incentive programs to complement the push for value-based purchasing, but some see pitfalls
The story is often told in the hallways of Massachusetts General Hospital: A chaplain, upon seeing a doctor leave a patient room without applying hand sanitizer, gently reminded the physician of the need to follow the organization’s hand-hygiene policy.
“The chaplain said, ‘If you don’t wash your hands, I won’t get my bonus,’ ” says Jeff Davis, senior vice president for human resources at the Boston hospital, recounting the story from several years ago.
Experts say such bonus plans, which offer frontline healthcare workers small financial perks when their hospitals meet clinical quality or patient-safety goals, are becoming increasingly interesting ideas to HR executives. Hospi- tal officials in California, Illinois, Massachusetts, New York and elsewhere have implemented such programs, and insiders say many others have started considering it.
Mass General has used one-time incentives for years. In the hand-hygiene example, employees received $100 each if the hospital met its goal of 90% hand-sanitizer use before and after patient encounters, as measured by secret monitors. The 907-bed hospital also has used bonuses for personal and organization-wide performance on flu vaccination documentation and receiving training on improving the patient experience, Davis says.
At the University of Illinois Medical Center in Chicago, a group of 1,150 unionized members of the Illinois Nurses Association recently struck a new three-year contract that spells out bonuses of up to $1,000 a year per nurse if the academic medical center achieves incremental increases in its patient-satisfaction scores in four clinical departments. The bonuses come in addition to traditional annual wage increases.
“We looked at it as, OK, this is something the employer is bringing forward,” says Alice Johnson, the INA program director who negotiated the contract. “I would say we’re very cautious about it, and we’ll see what happens with it. We didn’t see any detriment with it. It could potentially lead to more money for the nurses, but we’ll have to see as it’s implemented how it works out.”
Jan Spunt, chief nursing officer at the 467-bed hospital, says the nurses are aware that the hospital wants workers to think about the kinds of patient-satisfaction metrics that could lead to changes in Medicare reimbursements under the value-based purchasing program starting in January 2013—but that’s not the primary motivator for the bonus program.
“That is a motivator, and I communicate that to the staff so that they’re aware of it,” Spunt says. “But I also communicate to staff that we need to do it because it’s the right thing to do.”
Dr. Bryan Becker, interim chief medical officer at the hospital, says the program is a starting point. If it finds success, hospital officials might eventually try to open discussions of incentives related to other clinical-quality goals as well.
At least 25% of hospitals already have some type of financial performance-incentive system for frontline healthcare workers, and that figure is expected to grow in coming years, says Debbie O’brien, senior vice president of consulting and education services at healthcare performance--
Drs. Sheetal Patel, left, and Manuel Gonzalez check in on Ada Alexis at New York Methodist Hospital. Residents at the hospital receive bonuses if patient-satisfaction goals are met.