About 5 years ago, Texas Oncology moved to improve accountability and pathways compliance by introducing a pay incentive that put 2% to 3% of a physician’s pay at risk. The amount at stake for failure to achieve benchmarks was not huge, but the program worked, according to Lalan Wilfong, MD, who has served as administrator. The physicians had children’s private-school tuition and other large expenses to pay, and they were highly averse to any loss of income. “It really didn’t take a lot to have physicians’ anxieties raised enough to help with that pathways process,” said Wilfong, who discussed the incentive program at a recent meeting of the Community Oncology Alliance. With 420 physicians and 175 practice sites at Texas Oncology, there was much potential for divergence in pathways conformance. The oncology chain established an 80/20 rule: 80% was considered the optimal pathways adherence rate, and it was recognized that physicians would need to deviate about 20% of the time to address unusual patient cases. Under this system, physicians who achieved at least 75% compliance would receive 100% of their pay. After the incentive plan and the support tools were instituted, the compliance rate rose from the prior level of 78% to 89%, Wilfong said.
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