Can Sharing ENT Performance Bonuses With Staff Pay Off?

“Added” Money

Some private payers are beginning programs that will pay actual bonuses on top of regular reimbursements when certain goals are achieved. When additional money comes into the practice, equal division of the proceeds is recommended.

“I am firm believer that if everyone does the same amount of work, they should get equal pay,” said Dr. Hunter. “If we get the money, we’ll split [it] in a manner that is well understood.”

Not everyone agrees that this is a viable scenario in real-life situations, suggesting that even the bonus money should be folded in with the general incentives. “I think it would be more confusing to dole out money from a different pot,” said Dr. Smith. “We need to relay to our employees that new payment models mean that some of our reimbursement will be related to patient satisfaction, quality and other indicators that staff will impact on. The practice will take that into consideration, and their contribution will be rewarded.”

This is especially true in otolaryngology, as these practice groups tend to be much smaller. Fewer staff often means that there is less regimentation, with employees handling each other’s jobs at some time during each day. This makes it hard, if not impossible, to say who is responsible for what part of the bonus.

“Sharing also encourages everyone to be accountable to one another,” said Witt. “When each staff impacts the overall payment, it makes it easier for staff to have a conversation with their peers if they aren’t being patient centered. Their behavior affects everyone’s income.”

Communication

All those interviewed for this article agree that communication with the staff will be important, not only to make sure they are aware of what they need to do, but also to convey how important it is, both to them and the practice.

“It needs to be stressed that if the entire practice doesn’t do well on these measures, in many cases reimbursement may be lost,” said Seifert. “Money coming into the practice is no longer defined solely by volume but also quality and satisfaction outcomes. If we don’t move the needle on these things, we may not get as much money, and the impacts of not achieving these indicators are not good for the employee nor the practice.”

Care must also be taken in communicating that these payments to the practice, and thus to the staff, are not guaranteed. Even if the results are good one year, there can still be problems the next if the results fall. If employees don’t understand this, there could be hard feelings and anger later on.