Quick Care doctors would get bonuses in new pact

Thursday, Dec. 2, 2004 | 11:04 a.m.

Doctors working at Clark County's Quick Care centers could work under a new management plan that the county commission is likely to approve Tuesday.

The tentative plan, which provides cash bonuses for doctors depending on how many patients they treat, comes four months after the county commission authorized investigating outsourcing, or privatizing, the corps of physicians at the county's urgent care centers.

It also comes five months after the Quick Care doctors and the Service Employees International Union, the union representing most county employees, severed their relationship.

Instead of the union representing the doctors, they and officials from the county's University Medical Center, of which the Quick Cares are a unit, worked in smaller group discussions to draw up the plan.

Clark County Manager Thom Reilly said the plan provides incentives for doctors to work with more patients, improving the efficiency at the financially troublesome centers, but also provides safeguards to protect patient safety and quality of care.

"This model has a lot of merit," Reilly said. "It's an incentive-based model that builds in customer service as well as patient safety. It ensures that they're seeing enough patients but also providing good care."

Reilly said the plan eliminates longevity pay and merit increases for doctors, and the management plans is similar to those with county managers and attorneys. Unlike the managers and attorneys, though, the doctors would receive thousands in incentive pay for quick work.

Under the plan, full-time doctors at the 11 county Quick Cares would receive a salary of about $143,00 to $162,000 a year, or an hourly wage of a little more than $69 an hour.

Primary care physicians could receive quarterly bonuses of $5,000 for seeing four or more patients per hour. Doctors would receive at least $250 per quarter for seeing three or more patients per hour, with the amount increasing based on the number of patients, on average, that they see.

Another bonus ties the number of patients to the number of complaints. In addition to the basic quarterly bonuses, doctors could get up to $1,500 more per quarter for seeing four or more patients if they do not receive patient complaints. Any "legitimate patient complaint" would reduce the customer service bonus, which is only available to those doctors who see more than three patients on average per hour, by $250.

Under the plan, any doctor who achieves an average of four patients per hour would automatically have his or her medical records reviewed by a medical system administrator.

Reilly said those doctors who fall behind in the average face firing.

"The minimum standard for urgent care is 2.8 patients per hour," he said. "If they don't meet that three months in the year, they are subject to termination."

Clark County spokesman Erik Pappa stressed that the management structure is not a contract or agreement, although doctors had input into the plan.

"It's not a negotiated contract. It's our plan."

Several Quick Care doctors said the management plan and pay structure works for them.

"From the standpoint of all of us physicians, we are all encouraged," said Dr. Paul Christensen, a Quick Care physician for nine years and, before that, a doctor in private practice for 13 years.

He cited UMC Chief Operating Office Blain Claypool and UMC Associate Administrator Larry Trilops, who is the head of the Quick Cares, for their work on the agreement.

"Trilops came up with a plan," Christensen said. "Any plan will work as long as he's willing to work with the staff."

Christensen said previous arrangements worked out under the bargaining agreement with the union did not address the physicians' concerns.

Union officials did not immediately return calls Wednesday, but have in the past expressed concerns that the county would push the UMC system too hard in an effort to stop the fiscal bleeding that required the county to pump $38 million into the system in December 2002. County commissioners and administrators warned that such subsidies could not be sustained.

Privatization of the Quick Care pool of 60 to 80 doctors was one of a host of cost-cutting and efficiency moves considered by the county in response to the crisis, which county managers warned threatened the viability of the public hospital.

According to an analysis provided by the hospital administrators last spring, the Quick Care physicians make on average almost $195,000 a year in wages and benefits, more than $30,000 higher than the national average for doctors at urgent care centers.

Administrators said even a small increase in the number of patients that doctors see every hour -- about 3.3 an hour, according to the Quick Care statistics -- could result in millions of additional revenue for the hospital system.

Dr. Cory Russell, a UMC staff physician with a decade of experience working in the Quick Cares, said the arrangement is "pretty good" and would close the book on uncertainty for doctors in the system.

"We've been on pins and needles for so long," Russell said. "They are going to keep us on at the same rate, and they are going to compensate us for performance. It will reward those physicians who work hard."

The group discussions that produced the plan were fair to both sides, he said.

"We kind of met in the middle," Russell said.