ACC: Docs respond to both carrots, sticks

SAN FRANCISCO—Both carrot and stick approaches can be effective at inspiring recalcitrant cardiologists to change their behaviors. But whichever approach a manager takes, he or she must make an effort to make the process transparent. So advised a panel of cardiovascular leaders on March 9 at the American College of Cardiology (ACC) scientific session.

Mariell L. Jessup, MD, a panelist on a Meet the Experts session, shared her experience as associate clinical chief of cardiology at the University of Pennsylvania in Philadelphia and medical director of Penn Medicine Heart and Vascular Center. Recognizing that academic cardiovascular specialists juggle multiple and sometimes competing roles—educators, researchers, physicians—in a siloed environment, Penn devised a novel approach for getting this disparate group united.

“We were tasked with incentivizing this cardiac surgeon who may be up all night doing heart transplants and the vascular doctor who may be reading vascular studies and the heart failure doctor to get them to work together and feel like a team,” Jessup said.

The hospital agreed to set aside a pool of money for physicians and a separate pool for the group as a whole. If defined targets were met, then physicians as a group could decide how to use the funding.  The target: Increase the number of new patients entering the service line by 3 percent. Each specialty received a separate University Health Consortium (UHC) target.

It proved to be a strong motivator. As a team, they decided to add a quality care nurse and a new coder devoted to the service line, among other resources. “The negotiations on how to spend the money ended up to be a very positive effect on the dynamics of our group,” Jessup said. In addition the incentive created a cohesive service line, she added.

To communicate how well physicians and departments measured up, they provided quarterly statements with productivity, the UHC targets and, more recently related to billing, a percentage of charts that are closed within seven days. “It is a small amount of [incentive] money but it is surprising how that has helped us close our charts,” she said.

Panelist Matthew Phillips, MD, of Austin Heart in Texas, proposed that sometimes both carrot and stick strategies inspire the wanted response, citing the practice at some hospitals to name outliers in metrics reports. To encourage physicians to serve patients well, his institution provides bonuses to physicians and staff as a team if they achieve high patient satisfaction scores. “They win or they lose together,” he explained.

The outcomes have been positive, he said, with practices improving within two years from the 75th percentile to the 90th percentile in one ranking.

His system also began penalizing physicians who failed to complete charts within seven days by imposing a $25-a-day late charge. As compliance improved, they shortened the deadline, again with successful results. “You need incentives, but you also need sticks,” he said.

Panelist David C. May, MD, PhD, of Cardiovascular Specialists in Denton, Texas, emphasized that whatever approach a managing physician chooses, he or she should ensure that the process is transparent. “Physicians respond to data,” he said. If they see reliable data that shows a problem exists, they will fix it. “But it must be transparent. It makes your life immeasurably easier if everyone understands the metric before you tell them they are getting fined for it.”