Improving clinical productivity in the academic setting

A novel incentive plan based on utility theory

Madeline S. Wilson, Keith A Joiner, Silvio E. Inzucchi, Gary J. Mulligan, Mary F. Mechem, Cary P. Gross, David L. Coleman

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

PURPOSE: Academic internal medicine practices face growing challenges to financial viability due to high overhead, competing institutional missions, and suboptimal physician productivity. The authors describe the development of a clinical incentive plan for a group of academic subspecialty physicians at the Dana Clinic, an outpatient setting at Yale School of Medicine, and report on results of the first year's experience under the plan. METHOD: Utility theory was used to assess the risk profile of clinic faculty and identify incentive payments that would optimize faculty benefit or "utility" while minimizing departmental costs. Under the plan, physicians who reached a productivity target based on work Relative Value Units (wRVUs) between October 2003 and November 2004 had overhead costs covered and received a fixed payment to support salary; additional incentive payments were available for those exceeding the target. Physicians failing to reach the target were responsible for their own overhead costs and received no fixed payment. Physician productivity as measured by wRVU per full-time equivalent (FTE) was compared for the year prior to, and the year following, incentive plan introduction. RESULTS: Forty-seven members of eight academic sections were included in the analysis. Median productivity improved by 34%, with 42 of 47 physicians showing improvement. Significant improvements were also noted in collections (62%) and visit volume (23%), and shifts were observed in coding patterns. CONCLUSIONS: The unique threshold-based structure of the incentive plan, as determined through utility theory modeling, as well as permitting physicians to choose how to achieve the wRVU target were key features of its success, resulting in improved productivity without increasing practice resources or faculty salaries.

Original languageEnglish (US)
Pages (from-to)306-316
Number of pages11
JournalAcademic Medicine
Volume81
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

utility theory
Motivation
productivity
incentive
Economics
physician
Physicians
overhead costs
Salaries and Fringe Benefits
salary
Costs and Cost Analysis
medicine
Internal Medicine
Ambulatory Care Facilities
coding
Medicine
costs
resources
school

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Education

Cite this

Wilson, M. S., Joiner, K. A., Inzucchi, S. E., Mulligan, G. J., Mechem, M. F., Gross, C. P., & Coleman, D. L. (2006). Improving clinical productivity in the academic setting: A novel incentive plan based on utility theory. Academic Medicine, 81(4), 306-316. https://doi.org/10.1097/00001888-200604000-00003

Improving clinical productivity in the academic setting : A novel incentive plan based on utility theory. / Wilson, Madeline S.; Joiner, Keith A; Inzucchi, Silvio E.; Mulligan, Gary J.; Mechem, Mary F.; Gross, Cary P.; Coleman, David L.

In: Academic Medicine, Vol. 81, No. 4, 04.2006, p. 306-316.

Research output: Contribution to journalArticle

Wilson, Madeline S. ; Joiner, Keith A ; Inzucchi, Silvio E. ; Mulligan, Gary J. ; Mechem, Mary F. ; Gross, Cary P. ; Coleman, David L. / Improving clinical productivity in the academic setting : A novel incentive plan based on utility theory. In: Academic Medicine. 2006 ; Vol. 81, No. 4. pp. 306-316.
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