Curbside Consult with Dr. Jayne 10/9/12

Despite recent calls by some members of Congress to halt Meaningful Use incentive payments, providers are still gearing up to attest. The last 90-day reporting period for 2012 just began and it’s interesting to see people who haven’t yet been able to meet the requirements try to gear up and get it done.

I ran across an article that’s really timely. Basically it poses the question: Who gets the money? Whether providers are employed by large integrated delivery systems or whether they are partners in small practices, it’s often not clear how incentive payments should (let alone will) be allocated.

This doesn’t apply to just MU payments, but nearly any kind of pay for performance bonus, quality bonus, or capitation payment. Often physicians seem to be too busy actually caring for patients to spend the kind of up-front thought needed to solve these questions before they become practice-shattering issues.

The article presents a cautionary tale about a solo physician who employed a nurse practitioner in her office. After spending more than $50,000 to implement an EHR, the employee received the MU check and walked away with the cash, leaving the practice holding the bag. There’s probably more to the story, but it raises important questions about the intent of MU incentives and how they are paid.

The employed physicians working for our large health system have language in their contracts that basically state any incentives received for work done as an employee belong to the health system. In the event that they are paid to the physician personally, they are to be signed over to the health system who also has the right to pursue legal remedies to obtain the funds. The language is clear that it only applies to work done within the course of employment. It also requires providers to complete any assignment paperwork within 30 days of receipt or penalties apply (the same language applies to credentialing paperwork, conflict of interest documentation, employee code of conduct updates, etc.) It’s very “take it or leave it” and that’s part of what being in an employed situation is about.

The key here is that these stipulations are made clear during the hiring process – no surprises. Should the health system decide to be benevolent and actually share quality bonuses with physicians, it’s completely up to the leadership. Although it’s maddening as a provider because we’re doing the work, it’s understandable because none of us personally put up the $45,000 it cost to deploy our EHR system. The one time they did pass funding through to the physicians, I ended up with a whopping $40 bonus. I think at the time it covered about a week’s worth of interest on my student loan payment.

Even in small practices with physician partners, I’ve seen resentment between those who embrace EHR and enter the majority of the data and those who coast on the coat tails of their colleagues. There need to be minimum standards for data entry if payments are to be divided equally. This is not a lot different than the decisions that need to be made when partners who have capitation agreements cross-cover patients or when one partner takes more call or works less than another.

Bottom line: regardless of which side of the table you may be on, this needs to be addressed contractually before it becomes an issue. If you’re an employer and your providers haven’t brought it up yet, don’t assume they won’t be bitter when they figure out in the future that they should have. Be the bigger person and start the dialogue now. And if you’re an employee, be ready to discuss what kind of a split you think is fair and why you feel that way. Interesting discussions will certainly ensue and it may not be easy to avoid hurt feelings or bitterness on either side. Personally, after living through my last contract negotiation, I might just be inclined to arm wrestle for it.

How does your organization allocate incentive payments?

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