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

Modern Healthcare - - FRONT PAGE - Joe Carl­son

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.

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