FCA Physician Incentives

1. FCA Physician Incentives

2. The following have been found to be significant components of successful incentive programs • The size of the financial incentive; most 5% • The peer and/or consumer knowledge of individual provider performance • Ability to review performance compared to the group • The perceived and actual accuracy of the data on which the incentives are based; • The level of support for the incentive program in the medical leadership; • The practicing physicians’ knowledge and understanding of the performance • The simplicity and directness of the incentive Program

3. The level of trust between the physicians and the individuals and organizations implementing the incentives; The size of the financial incentive; The peer and/or consumer knowledge of individual Provider performance; The perceived and actual accuracy of the data on which the incentives are based; The stimulus and need for change recognized among physicians; The level of support for the incentive program in the medical leadership; The practicing physicians’ knowledge and understanding of the performance incentives/sanctions; and The simplicity and directness of the incentive program.

4. Physician's Salary and Incentive Payouts • Physicians across all organization types can expect to see median salary increases of 2.4 percent for 2014, on par with salary increases last year, according to results from Hay Group’s 2013 Physician Compensation Survey released today. Physicians in group-based practices can expect to see larger pay increases (3.7 percent) than those in hospital-based settings (2.2 percent). The prevalence of annual incentive plans for physicians remains steady at 63 percent, compared with 64 percent reported in 2012. The measures used to determine incentive payouts – both for individual and group performance – are reflective of providers’ shifting emphasis on quality and patient outcomes. For individual physician performance, there were upticks reported in 2013 incentive plan metrics related to patient satisfaction (70 percent), quality (86 percent) and outcomes (54 percent), compared with 2012 (66 percent, 77 percent and 39 percent, respectively). Group performance metrics in physician incentive plans tracked similarly upward for patient satisfaction (60 percent reported in 2013, compared with 50 percent reported in 2012) and quality (69 percent in 2013, compared with 56 percent in 2012). 

5. Federal Incentive Payments Available to Doctors and Hospitals to Adopt EHR Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Medicaid providers can receive their first year’s incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments. In 2015, the federal government will begin reducing payments to hospitals and doctors who are not using electronic health records. Source: Centers for Medicare and Medicaid Services. The Official Web Site for the Medicare and Medicaid EHR Incentive Programs. July 13, 2010. http://www.cms.gov/EHRIncentivePrograms/

7. Who uses incentives? • At Group Health Permanente, the Seattle-based integrated health system, 20 percent of primary care physicians’ compensation is tied to performance targets for clinical quality, patient satisfaction and productivity. Among other things, physicians are incentivized to make use of group visits, telephone visits and care management protocols.

8. In Minneapolis, the HealthPartners system also uses performance based pay. Compensation for primary care physicians employed by • HealthPartners Medical Group is based 87 percent on productivity, 3 percent on quality and service metrics, and 10 percent on participation in improvement activities. The Commonwealth Fund case study said that the move to productivity based pay was one factor responsible for a 38 percent increase in primary care hysician productivity over a four-year period.

10. The Quality Nexus HEDIS AHCA Star Rating PQRI PCMH

11. Cost Implications – Impact of MLR – Points Weighted

12. GENERIC REPORTING MEASURES Demographics ADMISSIONS Readmissions

13. Reporting Measures ED VISITS Pharmacy

14. Health Status Reviewed Each Provider – Risk Adjusted – Each condition would have specific reporting measures • Behavioral Health – Mental Illness • Preventive Health • Diabetes • Respiratory Disease • COPD • Asthma • Pneumonia • Hypertension • Renal Disease • Chronic Pain • Heart Disease

15. Prestige Incentives

16. Prestige Incentives

17. Prestige

18. Prestige incentives