ABSTRACT
BACKGROUND: Surgeons are critical for the success of any health care enterprise. However, few studies have examined the potential impact of value-based care on surgeon compensation. METHODS: This review presents value-based financial incentive models that will shape the future of surgeon compensation. The following incentivization models will be discussed: pay-for-reporting, pay-for-performance, pay-for-patient-safety, bundled payments, and pay-for-academic-productivity. Moreover, the authors suggest the application of the congruence model-a model developed to help business leaders understand the interplay of forces that shape the performance of their organizations-to determine surgeon compensation methods applicable in value-based care-centric environments. RESULTS: The application of research in organizational behavior can assist health care leaders in developing surgeon compensation models optimized for value-based care. Health care leaders can utilize the congruence model to determine total surgeon compensation, proportion of compensation that is short term versus long term, proportion of compensation that is fixed versus variable, and proportion of compensation based on seniority versus performance. CONCLUSION: This review provides a framework extensively studied by researchers in organizational behavior that can be utilized when designing surgeon financial compensation plans for any health care entity shifting toward value-based care.
Subject(s)
Fee-for-Service Plans/trends , Physician Incentive Plans/trends , Reimbursement, Incentive/trends , Surgeons/economics , Surgery, Plastic/economics , Efficiency , Fee-for-Service Plans/history , Fee-for-Service Plans/statistics & numerical data , Forecasting , History, 20th Century , History, 21st Century , Humans , Physician Incentive Plans/history , Physician Incentive Plans/statistics & numerical data , Reimbursement, Incentive/history , Reimbursement, Incentive/statistics & numerical data , Surgeons/statistics & numerical data , Surgery, Plastic/history , Surgery, Plastic/organization & administration , Surgery, Plastic/statistics & numerical data , United StatesABSTRACT
This paper compares the relative productive efficiencies of four models of primary care service delivery using the data envelopment analysis method on 130 primary care practices in Ontario, Canada. A quality-controlled measure of output and two input scenarios are employed: one with full-time-equivalent labour inputs and the other with total expenditures. Regression analysis controls for the mix of patients in the practice population. Overall, we find that community health centres fare the worst when it comes to relative efficiency scores.
Subject(s)
Community Health Centers , Delivery of Health Care , Fee-for-Service Plans , Physicians, Primary Care , Primary Health Care , Capitation Fee/history , Capitation Fee/legislation & jurisprudence , Community Health Centers/economics , Community Health Centers/history , Community Health Centers/legislation & jurisprudence , Community Health Services/economics , Community Health Services/history , Community Health Services/legislation & jurisprudence , Delivery of Health Care/economics , Delivery of Health Care/ethnology , Delivery of Health Care/history , Delivery of Health Care/legislation & jurisprudence , Efficiency , Fee-for-Service Plans/economics , Fee-for-Service Plans/history , Fee-for-Service Plans/legislation & jurisprudence , History, 20th Century , History, 21st Century , Ontario/ethnology , Physicians, Primary Care/economics , Physicians, Primary Care/education , Physicians, Primary Care/history , Physicians, Primary Care/legislation & jurisprudence , Physicians, Primary Care/psychology , Primary Health Care/economics , Primary Health Care/history , Primary Health Care/legislation & jurisprudenceABSTRACT
This article examines the development of the medical services in Saskatchewan with respect to physician remuneration from 1915 to 1949. In particular, it seeks to determine why the Co-operative Commonwealth Federation government of T. C. Douglas did not follow the recommendations of its Health Services Planning Commission for the establishment of a state salaried medical service based on the province's salaried municipal doctor system. The validity of the explanations in the established historical accounts of this policy decision is assessed based on empirical evidence. It provides a clearer understanding of how and why fee-for-service payment became entrenched in Saskatchewan Medicare.
Subject(s)
National Health Programs/history , Salaries and Fringe Benefits/history , Fee-for-Service Plans/history , Health Care Reform/history , History, 20th Century , Humans , SaskatchewanABSTRACT
In the move to critique managed care, the essential principles that first made it a reasonable alternative to fee-for-service medicine can easily be lost. Careful reflection on the history of early grassroots movements that created managed care, and on selected textual narratives of the founders of the managed care organizations at their inception, offers us insight into which of the critical premises and goals of that effort might be reclaimed as we analyze the current managed care environment.
