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Performance Reviews at the Hospital Means Pay for Performance for the Facility – Are the Quotas Being Met

Posted Jun 29 2010 4:30pm

This is probably not the first time you have heard this but these conversations are going on all the time at hospitals and other health care facilities due to economic image times.  Hospitalists are graded on their return admissions and each case is scrutinized by what actions they took and in many cases they have to check with a group of “consultants” before they can do much for you at all, and if they decide to go against what is approved, it’s back to standing up and making a real case due to the patient condition or illness.  These incentives are via Medicare and also are now included with the latest contracts with insurers.  Below is one I published today with Tenet and Cigna.  

Now when it comes to “quotas” some physicians are hearing “admissions are down” we need more.  Hospitals have a certain level of fixed costs that don’t change a lot and when the basics are not covered, people go digging for data.  Also what is not always taken into consideration is the overall demographics of patients and their illnesses/injuries and raw numbers are run to compare to other facilities.  One facility may see a larger number of patients with life threatening diseases than another; however when crunching statistics and working out doctor success rates too the number are skewed as cases and patients are varied. 

The algorithms for treatment approval and payment are getting so difficult to comprehend, even the peer meetings can’t figure them out, so when they get performance numbers the hospitals don’t have the foggiest sometimes on how they were really evaluated as they are proprietary algorithms from the insurers.  Medicare is different as that is open book on how they grade. 

In Texas last year when the doctors wouldn’t play and start admitting marginal patient, they were fired. 

In California, doctors cannot by law work for the hospitals, so we have this going on with doctors and hospitals suing each other as the doctors work for a group and the hospital wants to create a “new” group with new rules, etc.  It  is pretty ugly.  If the group does not meet their goals, well they just fire them and bring in a new group, or try to.  This situation here in California is a big, The City of Hope with cancer patients so you can see what damage is being done to patient care for the sake of money and using straight cold analytics to chop and reduce costs and staff with little human/patient interest at heart. 

Just be aware of some of this going on behind the scenes if you are admitted as an inpatient.  It’s the algorithms of patient care screaming for meeting goals and covering costs.  Some of the hospitals that put their own plans into effect actually ended up getting penalized even though they were having good results with re-admissions, etc. but they didn't’ follow and meet the proprietary guidelines of the insurers, so go figure there.  BD

But three years ago her hospital implemented a new computer-based performance system that broke her job description down into quantifiable goals such as to keep infection rates for her unit low and patient-satisfaction scores high. When review time came, the discussion didn't dwell on how she had performed—either she had hit the goals, or she hadn't.

It's the same sort of hard-facts review system that many organizations in the U.S. are adopting. And it's changing the way companies and professionals view success and how to get ahead in a career.

Knocked around by the recession, U.S. businesses are trying to overhaul evaluations in a way that better separates top performers from underachievers. According to Hewitt Associates , 10% of managers and 11% of other employees are now judged based solely on the results they achieve, as opposed to a combination of hard figures and softer behavioral characteristics, such as demonstrating corporate values or showing leadership, up from 7% and 8% five years ago. Nearly a third of professionals at an executive level are evaluated based solely on results, up from a little more than a fifth in 2005.

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