Use of pay for performance in a community hospital private hospitalist group: a preliminary report

We utilized a pay for performance contract to incentivize a private group of 12 hospitalists in an 1100 bed two hospital system. The contract included financial incentives for meeting standards in the areas of Access (24/7 in house coverage, < or =18:1 physician: patient ratio); Medical Records (history/physical dictated within 12 hours, discharge summary within 24 hours); Citizenship (attendance at monthly hospitalist meetings); Quality (JCAHO and National Patient Safety Goals); and Self Directed Learning (Society of Hospitalist Medicine membership). After the contract, the group maintained an 18:1 or less patient: physician ratio and provided 24/7 coverage. Medical record targets were met, and attendance at monthly hospitalist meetings was 100%. Although the contracted group did not consistently meet all JCAHO/CMS targets, compliance with most quality indicators improved to a greater extent than a concurrent non-contracted group. The preliminary results suggest that a carefully constructed contract and ongoing feedback of performance data may be effective in changing hospitalist behavior.