Pay Based on Patient Outcome

[MMiz]

As a teacher, my salary is based on my students' achievements on a year-end test. Legislators take the parents, students, and community out of the picture, and instead pin my student's achievements (as measured by some standardized test) on my skills and worth as a teacher.

Why not use the same for EMS? If your pay as an EMT was dependent on your patient surveys and measurable statistics, wouldn't you be a better medic? Would response times hasten? Would patient outcomes change?

 

[Epi-do]

I do not think something like that would be a good idea at all. There are so many variables, how could you realistically do something like that. What happens if you have a month where you are a sh*t magnet, and the majority of your runs are critically ill or injured people. Assuming you allways do your job to the best of your ability, is it fair that you get "punished" because your patient has a poor prognosis before you even get there. We all know that a massive CVA is catastrophic, if not fatal. Some trauma patients just aren't going to pull through, despite our efforts. Furthermore, how would you determine if the patient's outcome is better/worse due to the care recieved pre-hospital or post-hospital? What about frequent fliers, how would they affect things? Some people are going to call every chance they get, regardless of what we do or don't do for them. While the question you pose is an interesting one, I just don't see how it would ever be feasible in EMS.

 

[Ridryder911]

Well since cardiac arrest only has a < 2-3 % outcome, we could cancel all of EMS, and any trauma centers and surgeons..

The difference is teaching you have a predictable variable as well are able intervene on a daily basis, review techniques and re-intervene to correct or improve, where as EMS and medicine has more diverse variables and are unable to correct most of a lifetime of errors, and damage.

If you are getting reviewed strictly upon performance of students, that is a shame and flawed appraisal. There should be more than that. Teachers can only motivate students to want to learn, and guide and present materials for them to able comprehend and perform.

R/r 911

 

[MMiz]

Ridryder911,

My pay, like in many states, is based on my students' standardized test scores at the end of the year. It doesn't matter that the child comes from a background of abuse, was caught lighting the bathroom on fire, and is labeled as special needs... all that matters is my test scores on that one test.

What if you were provided cash at the end of the year if your "saves" or treatments were somehow better than others... again, measured by some scientific test?

Last year I struggled all year to get my students to pass one damn standardized test practice book. I mean I really struggled all year, and it was only about 10 or so kids. All year I never got more than half the kids to pass my damn practice test. At the end of the year I was ready to give up. I had a case of pop in my car, and offered each kid that passed the standardized practice test one if he or she passed. All but one passed.

Again, many states now pay teachers based solely on a test administered at the end of the school year. Schools, legislators, and communities support it. Why not do it in EMS?

 

[jeepmedic]

As a teacher, my salary is based on my students' achievements on a year-end test. Legislators take the parents, students, and community out of the picture, and instead pin my student's achievements (as measured by some standardized test) on my skills and worth as a teacher.

Why not use the same for EMS? If your pay as an EMT was dependent on your patient surveys and measurable statistics, wouldn't you be a better medic? Would response times hasten? Would patient outcomes change?

I do not like the way they do the teachers pay at all. My wife is a Teacher and she can tell at the beginning of the class how many and how is going to pass the SOL test. Sometimes she is supprised but for the most part she is right.

The problem is as I am sure you are aware of MMiz is you have students that do not try and you never see any parents untill the student fails. Then they want to know why there son/daughter failed. This is after you have sent letters home the whole class trying to get the parents involved.

Then the community as a whole wants to know what the problem is with the school systems. But you never hear from them untill the grades come back.

IF the stundents want to learn then Pay for Grades is great for the teachers if not all you will do is loose teachers.

 

[Ridryder911]

The reason you cannot judge pay in EMS versus standardized performance is in EMS you are already at a disadvantage.

Let's say in the past year you had 20% traumatic arrest and 30% cardiac arrest, 15% AMI, and 30 % medical calls, 5% non emergency, and most of these were above the age of 65. Your outcome is already shot, and expected results even with a surgeon on board would be < 5%.

As well we are already stacked with a loaded deck. Previous multiple illnesses, age, multiple problems and then many calls there is not + outcome ever!

EMS is very rarely with a patient long enough to cause or even create much changes. Most of our true job is prevention of further injury or illnesses, which is hard to validate if they do not occur.

Sorry, that your evaluation is obviously flawed. EMS evaluation should be on performance levels, education, professionalism, competence in administrating medical care, and the usual work related subjects (attendance, working with others, etc.)

Like I described, medicine is never black or white, nor may never have positive outcomes. I have worked in a town where over 85% of their population was over the age of 75. No one ever got a save, as well as multiple medical problems was quite common. Just keeping them alive was a chore.

R/r 911

 

[Mercy4Angels]

won't work.

 

[jeepmedic]

You could pay me for the calls I run though. I know some old medics that would be broke.

 

[firecoins]

patient outcome is not affected enough by first responders to be an effective way of judging performance.

I guess you can judge performance by how well they perform their duties, write proper reports, maintain and participate training and quality insurance.

 

[Summit]

so after a call where your patient tanks not only do you feel like :censored::censored::censored::censored:, you also get a pay hit??? whiskey tango foxtrot, over

 

[FF/EMT Sam]

You could pay me for the calls I run though. I know some old medics that would be broke.

Good idea! I'd be freakin' rich compared to the old timers at my station.

 

[Airwaygoddess]

Like my dad used to say, "I got a box full of thank-you's but I wish it would pay the bills!' ^_^

 

[firecoins]

There was a run of patients I had that were all terminally ill. 1 had cancer and literally breaking apart.

 

[Stevo]

it's been done Matt...

To determine their salary, the various doctors had to undergo examinations at the end of each year, judged in terms of the effectiveness of their treatments. The reward system for these examinations was: full salary for a 100% cure rate, and decreased salary based on the percentage of treatment failure. Thus, doctors were urged to improve their medical skill in order to achieve better compensation for their profession.

of course, we could be seen on the other end of the spectrum, metaphorically shaking the elderly and ill by their ankles for greens fees

statistically speaking of course, as the brunt of expenses for the terminal are accrued in the last six months

(excuse me)

FORE>>>>>>

(ahem, that's better....)


perhaps euthinasia might be something more than a hong kong disco should that ancient system ever come back around eh?

~S~

 

[wolfwyndd]

Interesting. While I do see the train of though going into this (both of my parents were teachers before they retired), I completely disagree with it. Teachers get scr$wed on pay as it is. Why should be take an already flawed system of reward / punishment and apply it to another already overworked and underpaid group of people. Ridryder is correct. We encounter people who have worked (or not worked) years to get where they are every day. We see people at their worst and many times they just DON'T get better. Basing our pay on their outcome isn't going to make them, or us, better off. IMO, it'll make their outcome worse because some of us may look at that cardiac arrest and go, 'well, gee, he's (she's) only got a small chance of surviving this, why should I bust my *** to save him? I'll get dinged if I don't same him and even if I do I still might get dinged because he's (she's) a vegetable on a ventilator. '

 

[slawson]

As a teacher, my salary is based on my students' achievements on a year-end test. Legislators take the parents, students, and community out of the picture, and instead pin my student's achievements (as measured by some standardized test) on my skills and worth as a teacher.

Why not use the same for EMS? If your pay as an EMT was dependent on your patient surveys and measurable statistics, wouldn't you be a better medic? Would response times hasten? Would patient outcomes change?

I simply think thats a horrible idea with absolutly no positive outcome - no offense.

 

[Stevo]

Teachers get scr$wed on pay as it is.

i got it!

no patient left behind

who'd a thunk it!

~S~

 

[oktom]

Performance based pay

As a teacher, my salary is based on my students' achievements on a year-end test. Legislators take the parents, students, and community out of the picture, and instead pin my student's achievements (as measured by some standardized test) on my skills and worth as a teacher.

Why not use the same for EMS? If your pay as an EMT was dependent on your patient surveys and measurable statistics, wouldn't you be a better medic? Would response times hasten? Would patient outcomes change?

Ok, this is my first post, but as an MBA I can't pass on the fun. Performance based pay is fine - but you have to base that performance on how well the employee does his her or her job - not random chance. Paying someone based on things outside of their control is a great way to suggest that all of your workers go somewhere else, especially the good ones.

As you say, you have to take the randomness out of it. Since what EMTs do is so extremely well documented and can be compared to what a physician diagnosed later - yes, it might work. If it's not a pay cut, but a bonus, it could probably be an effective part of a quality assurance (improvement) program.

Watch out for docking somebody's pay based on performance... you have to weigh the cost of that resentment against how much it improves things quality-wise. Studies have shown this to be a Bad Thing, IIRC. If it's for "uncommonly bad, but not bad enough to be fired behavior" it could work.

I'm curious... do you think performance based pay has helped teaching any? I've heard both good things and bad things.

By way of introduction, hello! I'm an IT guy who's always wanted to be an EMT (volunteer), and I'm in week 4 of an EMT-B class. I know you're thinking "whacker", and you're probably right.

Cheers,

Tom White
K5EHX

 

[Summit]

oktom excellent post

 

[BossyCow]

Again, many states now pay teachers based solely on a test administered at the end of the school year. Schools, legislators, and communities support it. Why not do it in EMS?

Okay, so you have an ineffective system for determining your wage and its so bad, so inappropriate that you feel it should be expanded to all fields? Teaching to the test rather than educating our children is wrong. I am confused about the purpose of your post. Are you seriously suggesting that we implement the type of system you work under for EMS or is this merely an attempt to garner pity?

If you desire to effect change in your place of work, the place to do that is in your workplace. My husband is a firefighter paramedic with a civil department who pays its garbage collectors more than either its teachers or its paramedics. You can whine about it, feel badly about it, quit the job or attempt to legislate or negotiate changes. But bottom line, you either find the work you do rewarding enough to continue doing it, or you find something else that better suits your financial/emotional/spiritual/physical/professional needs.