Dr. David Lubarsky et al. provides a detailed review article in the January 2019 issue of Anesthesiology. They look at financial incentives for physicians in general, with many specific examples related to anesthesiologists. Utilizing the framework of behavioral economics as well as a number of supporting studies, the authors describe issues to consider when designing and implementing incentive programs. The review details many of the premises of behavioral economics and links them to incentive program attributes. This article may be used for anesthesia (and other specialty) groups and facility administrators as they work to design performance metrics and associated financial benefits in a way to “maximize effectiveness and minimize unintended consequences.”
EHC NOTE: In the process of contract negotiations, we are frequently involved in the design and implementation of performance metrics linked to some portion of anesthesia subsidy. Sometimes designed as a withhold, sometimes as a “bonus”, the vast majority of hospitals and health systems expect metrics to delineate targets and expectations. The concepts detailed in the review article by Lubarsky et al. offers an excellent resource as to how incentive measures are designed. On a lighter note, much of the information contained in the article was presented by Dr. Lubarsky at the 2017 ASA Practice Management Conference. During the presentation, he was discussing the potential pitfalls in offering different compensation for the same work (this may relate to an Anesthesiologist, CRNA, OR Nurse etc.) There is apparently a fair amount of research in this area and he played a video highlighting one part of that body of work which is both informative and entertaining. If you have a minute (or 2 minutes and 43 seconds to be exact), check it out here.
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