The Evolution of the Physician Compensation Plan: Volume to Value

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Presentation transcript:

The Evolution of the Physician Compensation Plan: Volume to Value MGMA 2013 ANNUAL CONFERENCE The Evolution of the Physician Compensation Plan: Volume to Value Todd Evenson, MBA Vice President of Consulting Services and Data Solutions, MGMA-ACMPE

Today’s Business Compensation Plans Salary Salary plus Bonus Salary plus Bonus minus Expenses Salary plus Bonus minus Overhead © 2013 MGMA/ACMPE. All Rights Reserved.

Today’s Production Compensation Plans 100% Production Salary plus Production Production RVU Clinical Time Encounters Administrative Time © 2013 MGMA/ACMPE. All Rights Reserved.

Quality + Cost = Value Quality in 3 Main areas: Clinical Quality Quality of the Patient Experience Quality of Outcomes All areas with the emphasis on lowering costs ! © 2013 MGMA/ACMPE. All Rights Reserved.

Today’s Compensation Plans Should Be Strategic FFS Value Transition to Value-based Payment Quality Satisfaction Outcomes Shared Savings Strategy strives to maintain trajectory Performance Time

Making the move toward value… Current quality benchmarks: Consumer: healthgrades Angie’s List Word of Mouth Practice Patient Satisfaction Scores http://www.healthgrades.com/provider-search-directory/search?q=Pulmonology&prof.type=Provider&search.type=Specialty&loc=Reno%2c+NV+89511#pagenumber=1&sortby=bestmatch&isdirectory=&q=Pulmonology&loc=Reno%2C+NV+89511&prem=&f.specialty=57&f.distance.display=middle&f.distance_ftop=100&f.distance=100 © 2013 MGMA/ACMPE. All Rights Reserved.

Emerging Quality Benchmarks Physician Compare http://www.medicare.gov/physiciancompare/profile.html#selectedID=3072426881&addressID=11025553&viewmap=0&keyword=jackson&loc=Reno%2C%20NV%2C%20USA&lat=39.5296329&lng=-119.8138027&type=All&xpnd=1&vflg=1&ID=&expanded=dvpvdr Used by permission of Michael V. Jackson, MD © 2013 MGMA/ACMPE. All Rights Reserved.

Emerging Quality Benchmarks CAHPS Survey (Consumer Assessment of Healthcare Providers and Systems) Clinician and Group Surveys http://www.cahps.ahrq.gov/clinician_group/cgsurvey/patientexperiencemeasurescgsurveys.pdf © 2013 MGMA/ACMPE. All Rights Reserved.

Rating and Comparisons CAHPS Survey For internal benchmarking to database…. at present. http://www.cahps.ahrq.gov/clinician_group/cgsurvey/patientexperiencemeasurescgsurveys.pdf © 2013 MGMA/ACMPE. All Rights Reserved.

Payer Designated Quality Aetna Aexcel® www.aetna.com/plans-services-health-insurance/detail/assets/documents/Member-brochure.pdf Cigna Provider Excellence Recognition Directory www.cigna.com/healthcareprofessionals/resources-for-health-care-professionals/health-and-wellness-programs/quality-initiatives.html United Premium® Physician Designation Program www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Unitedhealth%20Premium/UnitedHealth_Premium_Detailed_Methodology_2012.pdf Medicaid Accountable Care Organizations © 2013 MGMA/ACMPE. All Rights Reserved.

NCQA provides physician quality assistance Physician Practice Connections® (PPC®) recognizes practices that use systematic processes and information technology to enhance the quality of patient care. Meeting PPC® standards shows practices have established connections to information, patients and other providers that allow them to: Know and use patient histories Follow up with patients and other providers Manage patient populations and use evidence–based care Employ electronic tools to prevent medical errors. There are nine PPC® standards and three levels of recognition. Practices seeking PPC® Recognition will complete a web-based data collection tool and provide documentation that validates responses. © 2013 MGMA/ACMPE. All Rights Reserved.

Value Based Reimbursement Quality - Based on PQRS participation and administrative claims for certain diagnoses Individual physician PQRS scores per measure compared with nationwide performance scores per measure Cost - Patient grouped into categories by degree of contact with physician Risk-adjusted, geography-adjusted to standardize for comparison Per capita costs computed for each group of patients Each physician’s per capita costs are compared with patient group of other physicians of the same specialty QRUR reports combine quality and resource use (cost) information http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PY2011-Individual-QRUR.pdf © 2013 MGMA/ACMPE. All Rights Reserved.

Physician Performance on PQRS Quality Measures in 2011 Exhibit 1. Physician Performance on PQRS Quality Measures in 2011 PQRS Measure Number Clinical Condition and PQRS Measure Specifications for PQRS clinical measures are posted at http://www.cms.gov/PQRS/Downloads/2011_PhysQ ualRptg_MeasuresList_033111.pdf PQRS Performance You All PQRS Participants Nationwide Number of Cases You Reported Performance Rate for Cases You Reported Number of Participating Physicians Reporting Cases Mean Performance Rate Diabetes Mellitus (DM) Measures Group 1 DM: Hemoglobin A1c Poor Control in Diabetes Mellitus % 2 DM: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus 3 DM: High Blood Pressure Control in Diabetes Mellitus 117 DM: Dilated Eye Exam in Diabetic Patient 119 DM: Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients © 2013 MGMA/ACMPE. All Rights Reserved.

Exhibit 5. 2011 Total Per Capita Costs for Specific Services for the [#] Patients Whose Care You Directed Service Category Medicare Patients Whose Care You Directed Average for Medicare Patients Whose Care Was Directed by [#] Physicians in Your Specialty in the Nine States Amount by Which Your Medicare Patients’ Per Capita Costs Were Higher (or Lower) than Average Your Medicare Patients Using Any Service in This Category Total Risk- Adjusted Per Capita Costs Medicare Patients Using Any Service in This Category Number Percentage All Services 100% $ $/($) Evaluation and Management Services in All Non- Emergency Settings Provided by YOU for Your Patients % Provided by OTHER Physicians Treating Your Patients Procedures in All Non-Emergency Settings Hospital Services (Excluding Emergency Outpatient) All Hospital Services Inpatient Hospital Facility Services Outpatient Hospital Facility Services Emergency Services That Did Not Result in a Hospital Admission © 2013 MGMA/ACMPE. All Rights Reserved.

Exhibit 7. Distribution of the 2011 Total Per Capita Costs of Patients Whose Care Was Directed by Physicians in Your Specialty in the Nine States © 2013 MGMA/ACMPE. All Rights Reserved.

MGMA DataDive

Quality and Satisfaction data/mgma.com/ptsat Quality Still in Formative Stages HEDIS CMS Percentage of Total Compensation Based on Quality Incentives: 3% Satisfaction Migration to CAHPS Percentage of Total Compensation Based on Satisfaction Incentives: 2%

Physician Compensation © 2013 MGMA/ACMPE. All Rights Reserved.

Models © 2013 MGMA/ACMPE. All Rights Reserved.

Value Compensation Models Internal quality relative values Assign relative values to the programs that assist to meet your practice goals. Good healthgrades scores/up-to-date profile = 200 RVUs EHR use = 500 RVUs Good internal CAHPS scores = 300 RVUs © 2013 MGMA/ACMPE. All Rights Reserved.

Value Compensation Models Bonus structure Carrot and stick Team goal rewards Citizenship credit Cost efficiency goals and QRUR scores Levels for: met exceeded © 2013 MGMA/ACMPE. All Rights Reserved.

Use the Models that Enhance Quality + Cost = Value Quality in 3 Main areas: Clinical Quality Quality of the Patient Experience Quality of Outcomes All areas with the emphasis on lowering costs ! © 2013 MGMA/ACMPE. All Rights Reserved.

Questions?