Minn. health care system changes way care providers are compensated

One major Minnesota health care system has changed the way primary care providers are compensated. Fairview Health Services has moved the emphasis from patient volume to quality outcomes and satisfaction.

MPR medical analyst Dr. Jon Hallberg calls the change a "dramatic shift." Hallberg previously worked as a Fairview physician. He's now a physician in family medicine at the University of Minnesota and director of the Mill City Clinic. He spoke with MPR's Tom Crann this week.

An edited transcript of their conversation is below.

Tom Crann: You call this a dramatic shift. Why is that?

Dr. Jon Hallberg: For as long as I've been in practice, and for years before that, if you'd been an employed physician, and I think even in private practice, you were compensated based on the number of people who see. It's as simple as that. A person comes in the door, you create a bill, and that's that.

Crann: Patient encounters.

Hallberg: That's right.

Crann: And how is it changing?

Hallberg: Well, this is very interesting. I think anyone in primary care knows, and I think many patients will realize, too, that primary care doesn't stop when the visit ends. There is so much coordination that goes on. There's so much follow-up care. But we don't technically get compensated for that. That all has to be done at the end of the day or at other times. And it gets very, very tricky if not impossible to provide really good care, especially when there's pressure on seeing more people.

Crann: And has that pressure been real in clinics, for doctors just to see another patient, keeping seeing them?

Hallberg: Oh, absolutely. Some systems really do put an emphasis on this, even for their primary care providers, that it's all based on volume. And there are times when quick visits are appropriate. They're easy to do. You can get a lot of people in and out quickly and provide good care, but then there are many times when that simply isn't possible, and it leads to great frustration I think both on patients' parts, but also the part of the provider.

Crann: Under this new Fairview method, how will doctors be compensated?

Hallberg: I don't know from the inside, but from what's being reported, 40 percent of the compensation will be based on measures, outside measures, how good of care are you providing as a provider, and how happy or satisfied are your patients? Then another 40 percent is based on the encounters with patients, but this is really different in that it'll include email correspondence and phone calls, not just that physical presence. And that's a big deal.

Crann: How will those ratings of quality outcomes — it seems subjective to me — how will they be determined?

Hallberg: Well, right. They're supposed to be very objective, but it's really tricky because the data that is looked at is only as good as the system that enters the data. In many cases it's really difficult.

For example, a person gets a flu shot. They get it at work, for example, and then they don't report that they had that. I don't have that in my chart, and then it looks as though that patient didn't get one when in fact they did. So it's really tricky, and I know that this is probably the point that makes most providers suspicious or concerned about this is that the data isn't accurate that their pay is being based on to some extent.

Crann: So are we going to see in medical care the same thing we see with all sorts of other customer service to get a form to fill out for a quality rating for our last visit?

Hallberg: Well, I don't think that's anything new, actually. We've been doing that for a while... We are no longer handing out the surveys ourselves in the clinic. This is something now that's mailed. There's sort of a third party that's doing this, and I think a lot of the major players are going to this kind of model, but we are rated. And it might be Angie's List, something that's sort of anonymous. So it's not really anything new. It's just that it really makes a difference now in ways that maybe it hasn't before.

Crann: And it can't be making every doctor happy.

Hallberg: No. I think that there's the thought that you want happy patients and happy patients are those who when they ask for something, they get it. And that's not always good medicine to be giving an antibiotic, for example, when it shouldn't be given. So that can lead to some problems, but I think that if you're honest and genuine about it, patients realize that, and they're not going to hold it against you for doing the right thing.

Crann: So in the end as you see it, Jon, do happier patients led to healthier patients?

Hallberg: I think on some level that is true. Certainly part of this compensation plan is based on the fact that those two things, patient satisfaction or happiness and good outcomes or health are very intimately related.

(Interview edited and transcribed by MPR reporter Madeleine Baran)

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