在2016年底之前，超过50%的医疗保险支付将包括基于价值的标准. The movement toward value-based reimbursement is pushing health systems, hospitals, and physician groups to improve quality while lowering costs. To meet this challenge, 组织需要将成本管理与云顶集团40011官网激励更紧密地结合起来.
Yet cost metrics have seldom been tied to physician pay, as they are historically challenging to measure, benchmark, and (perceivably) influence at the physician level. Furthermore, 传统上，政府不愿意授权云顶集团40011官网推动成本节约. Nonetheless, 一些组织已经有效地将成本指标纳入云顶集团40011官网支付方法. 成功的系统会设法让云顶集团40011官网参与进来，并赋予他们影响成本管理的权力. How? Initially, it is more palatable if only a small portion of compensation is tied to cost components; however, in time, with greater trust among physicians and management, a true dyad can emerge, enabling effective physician leadership and administrative management. 这种努力通常是一个过程，在这个过程中，提供者和管理部门在报告的实践数据中获得相互信任，并根据该信息采取适当的行动.
As organizations’ capabilities mature, 部分业务控制被放弃，让云顶集团40011官网参与成本管理. 这可以通过承担供应采购等领域的财务风险来实现, staffing ratios, and, ultimately, the total cost of care, 例如，表1确定了过去3年心电图医师薪酬调查中调查参与者报告的非生产性薪酬计划组成部分. While the use of nonproductivity measures is not currently widespread, 与前几年的比较表明，组织实际上正在将成本指标纳入其薪酬计划.
COMPONENTS OF THE COST EQUATION
评估一个适当的和可测量的成本指标是至关重要的，以获得云顶集团40011官网和实践管理人员的支持. 由于难以确定衡量绩效的基准成本结构，云顶集团40011官网和云顶集团40011官网实践难以将成本组成部分纳入薪酬计划. 组织可以从确定与组织目标和优先级最密切相关的成本度量开始. 如果选择的成本度量对组织的优先级不重要, 他们可能对实现组织的总体目标没有什么影响. 一些团队可能想要开发内部成本基准度量来衡量未来的绩效. For instance, 如果一个云顶集团40011官网或大型医疗集团专注于成本控制, 一个衡量成本占医疗总收入百分比的指标可能是最相关的.
Second, gaining physician buy-in and trust is vital. Unless cost control is a priority for physicians as well, meaningful gains will be difficult to realize. 云顶集团40011官网通常认为成本控制超出了他们的影响范围，甚至超出了他们的责任范围, 通常不考虑实践模式和患者满意度对成本的巨大影响. 表2确定了关注于跟踪运营费用和与临床相关活动相关的成本措施.
通常属于云顶集团40011官网权限的费用项目包括诊所供应和实践人员配备. As seen throughout the healthcare industry, hospitals and health systems are attempting to hold physicians accountable for these costs; however, 选择资源和利用的能力仍然超出了云顶集团40011官网的控制范围. 如果组织希望将薪酬激励结构与这些指标挂钩, 云顶集团40011官网需要在这些决定中有发言权，并有机会行使它.
云顶集团40011官网有重要控制的额外成本催化剂包括支持人员支出. However, before tying staffing-related cost metrics to compensation, the following considerations must be addressed:
- 云顶集团40011官网是否有动机最大限度地利用实践支持人员? 这包括围绕支持人员数量的关键成本考虑, as well as the role each plays.
- Are RNs, LPNs, or MAs used to support physicians? 成本较低的资源能否有效地用于部分或全部任务?
- 在选择和保留辅助人员(如患者云顶集团代表和其他临床人员)的决策过程中，是否应包括云顶集团40011官网?
- If APCs are utilized, does the billing model reflect the care model? If the physician is receiving production credit for APC work, cost accountability for this resource is likely appropriate.
Increasing awareness of these metrics, linking them to organizational goals, 在将成本指标纳入薪酬计划之前，获得云顶集团40011官网的支持以实现效率最大化都是至关重要的举措. 当云顶集团40011官网意识到他们可以直接控制医疗支出时, changes to the compensation plan will likely be met with less resistance.
INCORPORATING COST IN COMPENSATION
For organizations migrating to a compensation plan with cost components, a methodical approach is necessary to ensure more effective execution. The six steps 下图展示了如何识别成本组成部分 to incorporate into a compensation plan. This framework also describes the key sequencing of events, from attaining physician approval to including components that will affect future compensation plans. Executing this methodology helps make sure that the appropriate 云顶集团40011官网购买和成本指标的定义在计划之前进行审查 implementation.
TYING IT ALL TOGETHER
由于支付改革，医院和云顶集团40011官网的利润持续下降, 组织必须提高对护理总成本的敏感度. 因为云顶集团40011官网拥有在整个医疗连续体中显著影响成本的能力, 应更加注意将成本指标纳入薪酬计划设计. While this inclusion is a new concept for many physician organizations, 研究表明，在云顶集团40011官网薪酬中考虑成本因素的组织数量正在增加. 重要的是要记住，只有当所有利益相关者都信任并致力于这一事业时，成本控制工作才会有效. For this approach to be successful, great care must be taken to align costs with organizational objectives, engage physicians in plan design, and follow a clearly defined methodological approach.
Published March 14, 2016