I also would add Drive by Daniel Pink. We have the motivation thing all wrong in medicine . Thinking RVU payments will motivate is wrong . His book and videos on you tube show the right way to motivate .
Daniel F. O'Keeffe, MD
Cell: (602) 791-0176
The following equation was used to calculate the efficiency index (E):
The efficiency index was defined as a function of adjusted costs (Ca), adjusted number of patients (Na), and quality (Q). Constant b is an empirically determined adjustment factor so that the value of E remains between the limits of 0 and 1. Constant y was set at a value of 2. Higher values of y will further differentiate practices with low quality from those with higher quality. For example, if 2 practices had Q1 = 0.1 and Q2 = 1, y = 0.5 would result in effective Q values of 0.3 and 1, whereas y = 2 would result in effective Q values of 0.01 and 1. In effect, the higher the value of y, the more the practice with lower quality will be punished. The units of b are such that E is a value without units.
The adjusted number of patients (Na) was calculated from the numbers of follow-up patients (N1), new patients (N2), and surgical patients (N3). Adjustments for each type of patient (x1, x2, x3) were empirically derived from Medicare relative value units (RVUs) for each ophthalmology subspecialty, which reflect the type of examinations and surgical procedures typically performed on patients:
Subspecialties in this study included cornea, comprehensive, glaucoma, neuro-ophthalmology, oculoplastics, pediatrics, surgical retina, medical retina, and uveitis.
Adjusted cost (Ca) is a variable sensitive to the location of the practice and describes the ratio of the cost of caring for a given group of patients to the value of the care provided as determined by Medicare RVUs:
Medicare value of work is a function of the number of patients, RVUs for each category of patients previously mentioned, and geographic practice cost indices. The RVUs and geographic practice cost indices are determined by the Centers for Medicare and Medicaid Services (CMS) for each fiscal year. A more detailed explanation of the calculation for Medicare value of work is available in the eEquation in the Supplement. In total, 7 inputs from the physician's practice were required for the calculation of adjusted costs: (1) subspecialty; (2) location; (3) total number of new patients for a given period; (4) total number of follow-up patients for the same period; (5) total number of surgical patients for the same period; (6) total practice cost for that period (to care for the reported group of patients); and (7) the period under examination.
Quality (Q) in this study was a metric of medical process, as defined by the Donabedian model, and was scored by independent auditors masked to patient identities.6 For each practice, auditors used 20 randomly selected patient medical records and used patient-oriented quality questionnaires based on American Academy of Ophthalmology Preferred Practice Pattern.7Ten medical records were used to complete a questionnaire pertaining to a comprehensive eye examination evaluation, and the other 10 medical records were used to complete a questionnaire from 1 of 3 diagnostic checklists as chosen by the practice depending on its subspecialty or stated area of interest or expertise. The 3 diagnostic checklists were specific to patients with cataract, patients with glaucoma, or patients with age-related macular degeneration.