Does an incentive plan designed for an academic practice have applications in private practice? More specifically, can outpatient-focused radiology practices find something of value in an incentive plan that assigns points to various behaviors in addition to RVUs? An article by Edward Bluth, MD, chairman of radiology at Ochsner Clinic, in the May issue of the Journal of the American College of Radiology, describes an incentive plan implemented at Ochsner that put 10% of individual income at risk in a pool for distribution. And while an academic environment presents challenges to measuring individual contributions that are not found in private practice, issues related to measuring input in any practice are universal.
Each department was required to assign 10% of individual compensation to a pool for distribution. The radiology risk pool had two components: 80% of the pool was assigned to good-citizen activities expected to be achieved by all; the remaining 20% was earned through activities under voluntary personal control that would benefit the department. In order to help develop the list of activities and behaviors that would earn this part of the incentive pool, Bluth appointed an advisory incentive committee that consisted of 5 people: the chair (Bluth), vice-chair for clinical activities, vice chair for academic and research activities, and two elected members of the general department. This committee was also charged with developing a self-study document to be filled out by each participant and defining criteria and a point system to measure individual contributions.
The following list of activities was devised:
Resident lectures and case conferences
Committee work within the department, the institution, at the state and national levels
Development of new components of the practice or business
Attendance and participation in interdepartmental conferences
Institutional review board-approved research
Research presented by mentored residents or staff members at national and regional meetings
Papers submitted to peer-reviewed journals
Editorial board positions
Speaking at local, regional, and national meetings
Assignment as a resident mentor during a 4-year program
Timely signing of reports
Regular attendance at staff meetings
Teacher of the year
Clinical production (the top three producers were guaranteed to receive the mean number of points for departmental activities)
The committee reviewed the reports and graded the self-study reports submitted by each department member. To arrive at a dollar per point value, the total number of points achieved by all members was added and divided by the total dollars in the 2% pool. The radiologist’s incentive award was calculated by multiplying his or her number of points by the point value. Despite prevailing wisdom that an incentive plan must involve 20% to 30% of compensation to be effective, Bluth reported many positive outcomes in access, production, and scholarly activities generally attributed to the incentive plan, The number of points assigned to each individual ranged from 25 to 70, and the point value fluctuated between $100 and $200, depending on the 6-month period.