AJR: Pay for performance cuts rad report turn-around time
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In 2006, the Massachusetts General Physicians Organization at Massachusetts General Hospital (MGH) in Boston established a PFP program to measure radiologist report turn-around time (RTAT). The program reflected a hospital-wide, department-specific initiative to develop an easily measurable PFP program that was likely to succeed and have a positive impact on the quality of patient care. The program paid a semi-annual bonus to individual radiologists who met RTAT targets.
The research team, led by Giles W. L. Boland, MD, from the department of radiology at MGH, evaluated the impact of PFP at reducing RTAT and also assessed any negative impact of the termination of PFP.
Researchers assessed three RTAT measures during three time periods: exam completion to final report, exam completion to preliminary report and preliminary report to final report in the three month period before the program, immediately after initiation, and after termination of the program and used the Krusak-Wallis test to compare mean times.
Eighty-one staff radiologists representing 11 clinical radiology divisions participated in the study, which spanned July 2006 to March 2009.
“The primary goal was to provide radiologists with an incentive to reduce the preliminary to final component of the RTAT cycle because this was directly under the control of the participating radiologist,” wrote Boland and colleagues. To qualify for the bonus during phase one of the program from January to December 2007, radiologists were required to meet a 24-hour or less benchmark from preliminary to final turn-around time.
Beginning in January 2008, the total annual incentive was cut from $5,000 to $2,500 and the qualifying time was dropped to eight hours, except for neurointerventional radiology and neuroradiology, which remained at 24 hours. The program concluded on Jan. 1, 2009.
The mean exam completion to final report time dropped from 42.7 hours at baseline to 31.6 hours in the immediate period and 16.3 hours in the post-PFP period from January to March 2009. In addition, exam completion to preliminary report time dropped from 20 hours at baseline, 19 hours during the program and 11.9 in the post-PFP period.
Similar trends were observed divisionally and individually. The reduction in mean exam completion to final report was significant in all divisions except nuclear radiology and neurovascular radiology. Seven of the 81 radiologists did not qualify for incentives in the first measurement period from January to March 2007, and 10 did not qualify in the second period from January to March 2009.
“The PFP program appeared to achieve the desired effects … Interestingly, the trend continued to reduce even after the termination of the program,” wrote Boland and colleagues. In addition, the reporting component not directly influenced by PFP, exam completion to preliminary report, also decreased during the study.
Boland and colleagues noted that other factors may have impacted RTAT, including discussing expedited RTAT in a more formalized and consistent manner. Peer pressure also may have had a positive impact as mean turn-around times for all radiologists were available for electronic review.
“The effect of the PFP program was more profound two years after its introduction rather than during the immediate period after its introduction. This suggests it can take some months (or possibly years) for the PFP program to deliver its full effect,” wrote Boland and colleagues, who concluded that further studies are needed to determine the optimal financial incentive to meet RTAT requirements.