Physician penalty parameters

MGMA Connexion, Jul 2006

"In an effort to improve practice consistency within our organization, we are looking at imposing some sort of penalty on physicians who ignore the guidelines and protocols set up by the group. Could you share your thoughts, policies or protocols regarding chart completion, chart accuracy, rounding, call or whatever else your group has consequences for if physicians fail to comply with group decisions?"

Jim Hauguel. CMPE, MGMA member and practice administrator, First Care Family Physicians, Fort Wayne, Ind, jim@firstcarefamily.com, from the American College of Medical Practice Executives e-mail forum

Responses

"That was a good onct Ha ha ha ha ha. I've had groups do this in the past, hut it only lasts, oh, maybe one month. Good luck!"

"I have found that financial rewards for adherence to practice policies go further than a penalty for nonadherence and have the same ultimate impact. We usually set this up as a part of the bonus calculation those who arc 'good' get a bigger bonus. It also keeps the discussions on a positive basis - praising those who do well and giving less attention to those who do poorly."

"Once we tried such a maneuver. The worst offender in terms of submitting charges and medical records was a surgeon. When we put the plan into effect he simply asked how much the penalty would be and told us to deduct the entire amount from his next check - and said 'don't bother me again.'"

"We fine physicians for delinquent office dictation and delinquent/missing hospital billing information, Fine for office dictation- $100 per chart per week. (Physicians have 24 hours to complete dictation from date of service and have one week before penalty is imposed.) Fime for hospital hilling varies depending on frequency/ volume. We calculate it every six months based on percentage of missed charges out of their total charges. More than 3 percent is $500, more than 5 percent is $1,000. Anything less is acceptable. This has successfully affected behavior."

'In my previous private practice, physician shareholders voted for a nonrefundable $1,500/month 'corporate assessment' for unfinished dictation, regardless of number. One physician paid this fee for three years.

"In my current organization, physicians receive a base salary for 625 relative value units (RVUs) and a production bonus for any RVUs over that. In addition, they receive up to $9/RVU as a performance bonus tor completing dictation, turning in fee slips, etc. Once dictation is completed the physician receives all production bonuses over the base RVU, but if he/she has late dictation at the end of the quarter (when bonuses are calculated) he/she never gets the performance bonus. This seems to motivate borderline performers, although the people with severe dictation problems seem to stay true to form."

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The views expressed are those of the participants in MCMA's e-mail forums only and are not endorsed by MGMA. The views expressed do not constitute legal advice.