Primary care compensation at an academic medical center: A model for the mixed-payer environment

The authors' academic medical center, Brigham and Women's Hospital, Boston, Massachusetts, developed a primary care physician (PCP) salary; incentive program for employed academic physicians. This program, first implemented i n 1999, was needed to meet the financial imperatives placed on the institut ion by managed care and the Balanced Budget Act of 1997; its goal was to cr eate a set of incentives for PCPs that is consistent with the mission of th e academic center and helps motivate and reward PCP's work. The program sou ght to simultaneously increase productivity while optimizing resource utili zation in a mixed-payer environment. The salary incentive program uses work relative-value units (wRVUs) as the measure of productivity. In addition t o productivity-derived base pay, bonus incentives are added for efficient m edical manage-ment, quality of care, teaching, and seniority. The authors report that there was significant concern from several members of the physician staff before the plan was implemented; they felt that the institution's PCPs were already operating at maximum clinical capacity Howe ver, after the first year of operation of this plan, there was an overall 2 0% increase in PCP productivity. Increases were observed in all PCP subgrou ps when stratified by professional experience, clinical time commitment, an d practice location. The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands f or revenue self-sufficiency, managed care performance, quality of care, and academic commitment.