New work pay formats

My place of employment is going to be rolling out new pay schedules and is already trying some with a few providers. They are essentially going with a bonus structure RVU model with three different tiers. I would like some insight into what some of you would choose and why. Right now my average patient load is about 12 patients a day and that is 8 months in as a new NP. This is partially due to mixes of high no-show rates and still developing a solid patient panel.

Tier 1: Meeting overhead

-Essentially your overhead calculated with your annual salary, leave, office expenses (MA/Supplies/leave/cme/etc) are factored in, divided per quarter, then 30% of what you make past those numbers are what your bonus looks like.

Tier 2: Eat what you kill

-A number (based roughly on 30% of reimbursement) is assigned to each code we charge for. So a 212-5 each has a monetary value assigned to them. You are paid based on these direct charges and don't get PTO/CME/etc. Benefit is you can chose your work schedule more flexibly.

Tier 3: Simply meeting encounters based on number of visits

-This one is similar to Tier 1, but rather than meeting financial totals, they estimate a patient total based on expenses and add bonuses per quarter for meeting these goals. This can be any number of varied visit types and regardless of what you see or revenue is generated, the money is paid out.

I have ethical concerns on tier two. The way the numbers break out, there is incentive given to every-day office visits that are short and fast and you lose money on physicals that are more time-consuming. We have providers who are longer-term who are trying tier 2 because many of their patients are quick turn over patients. These patients are Typically in for refills and many are in for monthly opiates. These providers are seeing patients every 10 minutes in some cases.

As most of you have seen here, I am not opiate man. And I am a bigger fan of providing quality care of providing quality care over quantity. Just wondering your thoughts on these models, what you would personally choose, and why.