GPSC Fee Incentives
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GPSC Fee Incentives Buy What You Want Presentation to the QMA April 2011 Presented by Dr. Jean Clarke. 4 Priorities. $. Value us. Pay us. Support us. Train us. Barbara Starfield’s Key Attributes of Primary Care. Access Co-Ordination Comprehensiveness Continuity. The Triple Aim.

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GPSC Fee Incentives Buy What You Want Presentation to the QMA April 2011

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Gpsc fee incentives buy what you want presentation to the qma april 2011

GPSC Fee Incentives

Buy What You Want

Presentation to the QMA

April 2011

Presented by Dr. Jean Clarke


Gpsc fee incentives buy what you want presentation to the qma april 2011

4 Priorities

$

Value us

Pay us

Support us

Train us


Barbara starfield s key attributes of primary care

Barbara Starfield’s Key Attributes of Primary Care

  • Access

  • Co-Ordination

  • Comprehensiveness

  • Continuity


The triple aim

The Triple Aim


Overview

Overview

  • Chronic Disease Management

  • Complex Care

  • Conferencing

  • Palliative Care

  • Mental Health

  • Prevention

  • Maternity


Gpsc initiatives

GPSC INITIATIVES

CHRONIC DISEASE

MANAGEMENT


Chronic disease management

Chronic Disease Management

Diabetes Mellitus - $125.00

Congestive Heart Failure - $125.00

Hypertension - $50.00

COPD - $125.00

COPD Telephone/E-mail follow up - $15.00 (billable up to 4 times in the 12 months)


Gpsc fee incentives buy what you want presentation to the qma april 2011

The CDM fee is a management bonus billable annually on the anniversary of the initial billing date.

The CDM fees are for the GP who has accepted responsibility for the ongoing, longitudinal care of the patient.

Must have at least 2 visits with patient in 12 months preceding billing of CDM fee.

FFS billing for office visits continues.

Chronic Disease Management


Chronic disease management1

Chronic Disease Management

Diabetes, CHF, and COPD CDM fees may be billed for the same patient.

Hypertension CDM fee is not billable if also billing for Diabetes and/or CHF (but is billable with COPD.)

Use of flow sheets as a tool for tracking care is encouraged but not mandatory provided all required information is included.


Gpsc initiatives1

GPSC INITIATIVES

COMPLEX CARE


Gpsc fee incentives buy what you want presentation to the qma april 2011

Payment to compensate for the extra time required to provide planned care to complex patients who are living in their home or in assisted living.

Payable only to the General Practitioner who accepts responsibility for the longitudinal, coordinated care of the patient.

Complex Care


Complex care

Complex Care

Eligible patients must have two of the following chronic

conditions:

Diabetes mellitus

Chronic kidney disease

Congestive heart failure (CHF)

Cerebrovascular disease (CVD)

Ischemic heart disease (IHD)

Chronic respiratory condition

Chronic neurodegenerative diseases (CND)

Chronic liver disease (CLD)


Gpsc fee incentives buy what you want presentation to the qma april 2011

Annual Complex Care Management fee - $315

Minimum 30-minute complex care planning process:

The Complex Care Planning Visit: the development of the care plan is done jointly with the patient. The patient should leave the appointment knowing there is a plan for their care and what that plan is.

Billed in addition to office visit fee on the day of the planning appointment.

Complex Care


Gpsc fee incentives buy what you want presentation to the qma april 2011

FFS billing for subsequent office visits continues.

CDM fees and Conferencing fees are payable in addition.

Complex Care


Gpsc fee incentives buy what you want presentation to the qma april 2011

Complex Care Telephone/E-mail Follow-up Management fee $15

Payable for up to 4 non face to face encounters (telephone, email) in the 18 months following billing of the Complex Care management fee

Telephone/Email (2 way) encounters may be provided by the GP or delegated staff. Not for simple appointment reminders or prescription renewals

Complex Care


Gpsc initiatives2

GPSC INITIATIVES

CONFERENCING FEES


Conferencing fees

Conferencing Fees

Community Patient Conferencing fee

Facility Patient Conferencing fee

Acute Care Discharge Planning Conferencing fee

Telephone Consultation with a Specialist or GP with Specialty Training


Conferencing fees1

Conferencing Fees

Developed to compensate the GP for time spentconferencing with other health care professionals to make acoordinated clinical action plan for the care of patients with more complex needs.


Conferencing fees2

Conferencing Fees

The Community, Facility and Acute Care Discharge conferencing fees are for the same eligible patient population:

Frail elderly (ICD-9 code V15)

Palliative care (ICD-9 code V58)

Mental illness

Patients of any age with multiple medical needs or complex co-morbidity – pregnancy is considered a co-morbidity in complex maternity patients.

Payable in units of $40.00 per 15 minutes or greater portion. Maximum 4 units/patient/day; 6 units/patient/year.


Gp urgent telephone conference with a specialist fee

GP Urgent Telephone Conference with a Specialist Fee

Intent is to improve management of the patient with acute needs, and reduce unnecessary ER or hospital admissions/transfers.

Billable when the patient’s condition requires urgent (< 2 hours from time of request) consultation with a specialist or GP with specialty training, and the development and implementation of a care plan within the next 24 hours to keep the patient stable in his/her current environment.

This fee is not restricted by diagnosis or location of the patient, but by the urgency of the need for care.

$40 flat rate fee value.

Billable in addition to visit fee.


General practitioners with specialty training telephone advice fees

General Practitioners with Specialty Training Telephone Advice Fees

“General Practitioner (GP) with Specialty Training” is defined as “A GP who has specialty training and who provides services in that specialty area through a health authority supported or approved program.”

“Mirror fees” to the SSC Specialist Telephone Advice fees for FRCP certified Specialists.

Service may be provided when physician is located in office or hospital.

Telephone advice must be related to the field in which the GP has received specialty training.


General practitioners with specialty training telephone advice fees1

General Practitioners with Specialty Training Telephone Advice Fees

GP with Specialty Training Telephone Advice - Initiated by a Specialist or General Practitioner, urgent (< 2 hours from request for advice) - $60.00.

GP with Specialty Training Telephone Patient Management - Initiated by a Specialist or General Practitioner, one week - $40.00.

GP with Specialty Training Telephone Patient Management / Follow-up - $20.00; maximum 4/year/patient.


Gpsc initiatives3

GPSC INITIATIVES

PALLIATIVE CARE


Palliative care

Palliative Care

Palliative Care Planning fee - $100

Payable for the development of a Palliative Care Plan for patients who have reached the palliative stage of a life-limiting disease or illness.

Requires a face-to-face visit with the patient or the patient’s representative.

Medical Diagnoses include: end-stage cardiac, respiratory, renal and liver disease, end-stage dementia, degenerative neuromuscular disease, HIV/AIDS or malignancy.

Eligible patients must be resident in the community: at home or in assisted living or supportive housing.


Gpsc fee incentives buy what you want presentation to the qma april 2011

Palliative Care Telephone/E-mail Follow-up Management $15.00

This fee is payable for 2-way telephone or email communication with eligible patients or their representative to provide clinical follow-up management

billable by the GP who has developed the patient’s Palliative Care Plan

Billable up to 5 times..

Palliative Care


Gpsc initiatives4

GPSC INITIATIVES

MENTAL HEALTH


Community gp mental health

Community GP Mental Health

Mental Health Initiative compensates the Family Physician who accepts responsibility for the longitudinal care of patients who:

Have an Axis I diagnosis confirmed by DSM IV criteria

With a severity and acuity level causing sufficient interference in activities of daily living that developing a management plan for the rest of the year would be appropriate.


Gpsc fee incentives buy what you want presentation to the qma april 2011

GP Mental Health Planning fee - $100.00

Paid for the development of a Mental Health Plan for care during the subsequent calendar year for patients who reside in the community.

Requires 30-minute face-to-face visit.

Billable once per calendar year per patient.

Allows billing for 4 additional annual counselling visits

GP Mental Health


Gpsc fee incentives buy what you want presentation to the qma april 2011

GP Mental Health Telephone/Email Management fee - $15

This fee is payable for up to 5 telephone/email services (2-way communication) with eligible patients or their representative via telephone or email for the provision of clinical follow-up.

Available for up to 18 months after billing Mental Health fee.

This fee is not to be billed for simple appointment reminders or referral notification.

Community GP Mental Health


Gpsc initiatives5

GPSC INITIATIVES

PREVENTION


Prevention fee

Prevention Fee

Personal Health Risk Assessment fee- $50

Billable in addition to an office visit, to undertake a personal health risk assessment visit with “at risk” patients.

Targeted patients include those with:

Smoking

Unhealthy eating

Physical inactivity

Medical obesity.

GP is expected to develop a plan that recommends age- and sex-specific targeted clinical preventative actions of proven benefit.

Billable for up to 100 patients per calendar year per physician.


Gpsc initiatives6

GPSC INITIATIVES

MATERNITY INITIATIVES


Gpsc obstetric delivery bonuses

GPSC Obstetric Delivery Bonuses

Delivery bonuses valued at 50% of delivery fee.

Available to GPs who in addition to being paid the delivery fee for the patient are also responsible or share responsibility for providing the patient’s longitudinal primary care.

Maximum total of 25 bonuses claimed per calendar year.


Maternity network payment

Maternity Network Payment

Quarterly payment to encourage shared care of obstetric patients to reduce burnout.

$2100 per quarter.

GPs complete a network registration form for the group.


Some key findings from the evaluation

Some Key Findings From the Evaluation

  • Hollander Analytical Services Ltd.

  • 300 - 895 Fort Street

  • Victoria, BC V8W 1H7

Tel: (250) 384-2776

Fax: (250) 389-0105

E-Mail: [email protected]


A major new finding

A Major New Finding

  • A major, new finding is that there is a clear inverserelationship between the level of attachment to a primary care practice, and costs, for higher care needs patients. Attachment is defined as the percentage of all GP services in one year provided by the practice which provided the most services.


Benefits of attachment

Benefits of Attachment

  • The more patients go to the same practice, the lower the overall, annual costs to the health care system.

  • Most of the differential in costs between more attached and less attached patients is in hospital costs: costs are higher for less attached patients

  • Therefore, activities which foster increased attachment of patients to a particular primary care practice have the potential to reduce health care costs i.e. continuity of care is cost-effective.


A major new finding cont d

A Major New Finding (cont’d)

  • Our findings are based on an analysis of diabetes and congestive heart failure patients. A classification system developed by Johns Hopkins University was used to ensure that people in the analysis had similar levels of care need.

  • Resource Utilization Band (RUB) 4 represents people with a high need for care. RUB 5 represents people with a very high need for care.


Gpsc fee incentives buy what you want presentation to the qma april 2011

Major new findings

Annual costs per patient as a function of attachment to practice, for diabetes patients at RUB 4: Fiscal 2007/08


Gpsc fee incentives buy what you want presentation to the qma april 2011

Major new findings

Annual costs per patient as a function of attachment to practice, for diabetes patients at RUB 5: Fiscal 2007/08


Gpsc fee incentives buy what you want presentation to the qma april 2011

Major new findings

Annual costs per patient as a function of attachment to practice, for CHF patients at RUB 4: Fiscal 2007/08


Gpsc fee incentives buy what you want presentation to the qma april 2011

Major new findings

Annual costs per patient as a function of attachment to practice, for CHF patients at RUB 5: Fiscal 2007/08


Cost of care as a function of attachment cont d

Cost of Care as a Function of Attachment (cont’d)

For the four main groups of patients reported in the study, total cost savings per 5% increase in attachment is estimated as:


Gpsc fee incentives buy what you want presentation to the qma april 2011

Incentives

RISQY


Gpsc fee incentives buy what you want presentation to the qma april 2011

Major new findings

Annual costs for CDM patients who did, and did not, receive incentive-based care, standardized for difference in age, gender, RUB and attachment levels: Fiscal 2008/09


Gpsc fee incentives buy what you want presentation to the qma april 2011

Number of GPs participating in GPSC initiatives


Uptake of incentive billings over time fiscal 2003 04 to 2009 10

Uptake of Incentive Billings Over Time: Fiscal 2003/04 to 2009/10

Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.


Gpsc fee incentives buy what you want presentation to the qma april 2011

Percentage of GPs Billing for Chronic Disease Management Incentives Over Time: Fiscal 2003/04 to 2009/10

Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.


Msoc patients over time based on care provided to all patients for regular gps

MSOC Patients Over Time Based on Care Provided to All Patients for Regular GPs

Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.


Quality

Quality

RISQY

Diabetes patients receiving 2+ HbA1c tests per year


Quality1

Quality

RISQY

Mean total acute and rehab days per patient by physician


Gpsc fee incentives buy what you want presentation to the qma april 2011

Health Indicators for Diabetes Patients 2002/03 Death Rates For Patients Alive March 31, 2006 Excluding Patients 85 and Over as of March 31, 2002

Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.


The bottom line

The Bottom Line

  • 80% of GPs surveyed in 2010

  • $$$ cost avoidance

  • Professional satisfaction

  • Payer satisfaction


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