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How Should Physicians Determine Productivity?


The practice of medicine is quantifiable in many ways, not just dollar value.

A job is generally defined by an area of responsibility, a set of tasks, and a defined scope of activity with key objectives at the forefront. Job performance is based on how well an employee meets or exceeds those defined goals. Successful employees recognize the need to manage more than just those goals, but rather, to help set them. They take an active role in defining their job by showing initiative, taking measured amounts of risk, and by carefully participating in areas that go beyond their immediate responsibilities.

It is not always easy to recognize how to add value to a company without stepping on the toes of management. Successful companies encourage motivated employees and the exchange of new ideas and initiatives. There is tremendous value in helping management recognize opportunities that help the company. Thanks to a major shift in healthcare, this is truer for physicians today than ever before.

According to a study done by the Physicians Advocacy Institute, one-in-four medical practices is now owned by a hospital or health system, and hospitals employed 38 percent of all U.S. physicians in 2015. The administrative burdens that come with running a private company have created an environment that is more attractive, particularly for younger physicians, for a role as an employee. The independent physician with the entrepreneurial spirit is becoming a rarity.

Employed physicians have defined job responsibilities related to their compensation, and it's not always about a flat salary. Unlike other industries, the practice of medicine is quantifiable in many ways including productivity, efficiency, and quality measures. However productivity, the quantity of a physician's work, is only one of the factors that impact the economics of productivity. The method and rate of third party reimbursement is the other half of the productivity measure. Not everyone is judged just by Relative Value Units -the ''pie'' is determined by dollars collected, not just the work performed. In an environment where rates are in flux, there must be other ways for employed physicians to create real economic value.

That’s why employed physicians all over the country are looking at many of the consumer-driven initiatives that private physicians have successfully developed so that they can change the formula that determines economic productivity factors. More and more, employed physicians are introducing concepts like hybrid concierge to their management. A hybrid concierge model allows a physician to offer patients the option of joining a membership program for enhanced healthcare service. The program is offered as an optional service that a patient can elect to purchase-it’s not mandatory. Typically, a small percentage of the patient panel will join the hybrid program, but even though the numbers may be small, the boost in collected revenue can be very significant.

Unlike full model concierge programs that force all patients to join, the hybrid model is unique because it adds a new revenue source to a practice while still working in concert with the business model of the larger entity. Delivery systems like hospitals do not have to worry that patients will be dismissed. Referral networks remain intact. Relationships with third party payers are not affected. The hybrid program simply exists alongside the traditional practice and adds a new revenue source that comes directly from the patients. It’s a win for the employed physician, who has introduced a way to add real economic value to their practice, a win for the group as more revenue is generated, and a win for patients, who want and are willing to pay for a closer relationship with their physician.

Many large delivery systems already employ physicians with hybrid programs, as more and more physicians become employees, there is no doubt that this trend will continue to grow and expand. 

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