Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department

The authors describe the implementation and first three years (1997-1999) o f a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedic al Sciences. By using a consensus approach, a representative elected commit tee designed a clinical relative value unit (explained in detail) that coul d be translated to equally value and reward faculty efforts in patient care , education, and research and which allowed the department to avoid the imp osition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hou r session had been exceeded for pure clinical care. Clearly, only a small f inancial incentive was necessary tin 1999, an incentive pool of 4% of provi ders' gross salary) to motivate the faculty to be more productive and to se lf-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, o r 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modi fications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing infor mation from the associated teaching hospitals, the inherent problems of sel f-reported information, difficulties of gaining buy-in from the faculty, an d inherent risks of a pay-for-performance approach. But the authors conclud e that the plan is fulfilling its goal of effectively and fairly quantifyin g all areas of faculty effort, and is also helping the department to more e ffectively demonstrate clinical productivity in negotiations with teaching hospitals.