Pay-for-performance initiative markedly improves radiologists’ quality and safety successes
Launching a pay-for-performance quality improvement initiative has helped Brigham and Women’s Hospital dramatically improve radiologist performance on key quality and safety metrics, according to a study published Thursday.
The Boston-based, Harvard-affiliated institution has produced a nearly 21% drop in the time between completing an imaging scan and a radiologist signing off on the final report. And the vast majority of physicians closed out more than 90% of critical alerts thanks to the effort, Sheila Enamandram, MD, MBA, and colleagues wrote in JACR.
They believe their success offers important lessons for imaging providers in today’s rapidly shifting delivery landscape.
“As our nation’s healthcare system continues to evolve toward a compensation-for-quality model, these quality-based compensation models may become increasingly important for academic practices and large private or corporate practices to compete in the marketplace,” Enamandram, who studied medicine at Harvard and is now a diagnostic radiology resident at Stanford, and co-authors wrote Jan. 28.
Brigham and Women’s implemented three outcome measures back in October 2017, targeting report signature timeliness, the communication of critical results, and peer learning between radiologists. They looked to incentivize performance improvement by creating both individual and division-wide goals and shared everyone’s daily results via an intranet dashboard. The institution also rewarded progress with quarterly incentive pay totaling 5% of physicians’ salaries.
The initiative appears to have paid off. Comparing outcomes during the year leading up to the effort and the 12 months that followed, Enamandram and co-investigators found that monthly 90th percentile ccompletion-to-final-report-signature times dropped from 21.1 hours down to 16.7. Between 95% and 98.4% of radiologists achieved greater than 90% timely closure of critical alerts. And all divisions exceeded the target of 90 peer-learning communications each quarter, the authors wrote.
Team members attributed their success to three factors:
- Radiologists and division leaders helped choose the quality metrics, giving faculty power over their own performance.
- Their intranet dashboard gave leaders daily data updates, allowing radiologists and department heads to feel actively engaged in fostering change.
- Metrics allowed radiologists the to “achieve mastery and find purpose in their work,” ensuring they stayed motivated financially and intrinsically, the authors noted.
Enamandram et al. additionally underlined the importance of flexibility, modifying measurements as radiologists achieved success.
“Arguably the biggest strength of the [radiology patient outcome measures] program is that it is structured in such a way that the incentivized target metrics can be changed once maximum gains from any single target are achieved,” they wrote. “This ensures that the benefit of the program will persist beyond the individual measures themselves…”
You can read much more about the initiative in the Journal of the American College of Radiology here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.