59 Designing a physician reimbursement contract

• Published in: BMJ leader Vol. 2; no. Suppl 1; pp. A24 - A25
• Main Authors: Htat, Wa Thon, Monnickendam, Charlotte Sara, Liu, Hui Yu Qing, Zudilova, Maria, Badran, Ismail Ahmed, Tan, Yan Hao
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2018
• Subjects: Health care management; Information systems; Leadership; Physicians; Quality of care; Wages & salaries
• ISSN: 2398-631X; 2398-631X
• DOI: 10.1136/leader-2018-FMLM.57

Healthcare spending in most of the Organisation for Economic Co-operation and Development countries is expected to reach up to 14% of GDP by 2060. Physicians as the primary point of contact across the healthcare continuum and being largely in control of the clinical process are well-positioned to influence the cost and quality of healthcare, as well as to lead and shape healthcare improvements. Thus, it is essential to design the most appropriate reimbursement model that can support and drive the desired physician behaviours.In this article, a hybrid compensation model is proposed which comprises of a base salary and individual bonus – where base salary is pegged at the average market rate according to the physician’s qualifications, skills and experience, and the individual bonus is adjusted according to both the ‘group-level’ and ‘individual-level’ performance.The proposed reimbursement model has the flexibility to be applied in different care settings after tailoring the performance metrics to suit the organisation’s desired goals, e.g. using indicators from the NHS’s Quality and Outcomes Framework for a primary care setting. However, administering the physician’s incentive component in our proposed model would likely be relatively complex, given the need to account for the physician’s ‘group-level’ affiliations, which could range from the physician’s role in a specific clinical program to his/her association with the parent clinical department. Thus, it would be crucial to ensure that the necessary supporting resources and infrastructure are in place, e.g. robust information systems that can measure, collect, analyse and report data in an accurate and timely manner, which would coincide with health organisations’ increasing focus on the use of information systems in delivering effective value-based healthcare.