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Part A Support including Performance-based Incentives. West, Midwest & Canada Regional APC/PDAS Meeting. HBP Services 11 Research Drive , Suite 2 Woodbridge, CT 06525 203 397-8000 [email protected] www.hbpworld.com. October 21-24, 2014. Robert H. Tessier

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Part a support including performance based incentives

Part A Supportincluding Performance-based Incentives

  • West, Midwest & Canada Regional APC/PDAS Meeting

HBP Services

11 Research Drive , Suite 2

Woodbridge, CT 06525

203 397-8000

[email protected]

www.hbpworld.com

October 21-24, 2014

Robert H. Tessier

Senior Reimbursement Consultant


Performance based incentives
Performance Based Incentives

Performance Based Part A – WHAT IT IS NOT/WHAT IT IS

How To Proceed?

Performance Based Checklist

Part A Fact Book

Page 3

Page 7

Page 9

Page 15

Implement performance based incentives to include in your

Part A contract.


Performance based part a what it is not
Performance Based Part A- What IT IS NOT

The foundation for Part A support will continue to be the hours documented, paid at a

“reasonable” hourly rate. HBP always uses the Medicare Reasonable compensation

Equivalent (RCE) adjusted by 3% inflation +$5,000 CME and actual cost of Malpractice.

IT IS NOT:

  • a replacement for the need to document Part A services and prepare Time Studies.

  • a solution for those Pathologists who don’t want to be judged on results.

  • a concept to be used for those who ASSUME the Hospital knows your value.


Performance based part a what it is not1
Performance Based Part A- What IT IS NOT

IT IS NOT:

  • intended for those who do not take the time to provide a effective education to administration.

  • a series of simple calculations that eliminate the need for dialogue with the Hospital.

  • a good approach if the goals of the Hospital are not aligned with those of the Pathologists.

  • the right methodology when the Pathologists only perform required Part A functions.

  • a static formula that can be applied over a multi-year contract.


Performance based part a what it is
Performance Based Part A - What IT IS

IT IS:

  • A new approach for those Pathologists with a great story to tell.

  • An opportunity to formally discuss results with Administration.

  • A reward for those who can demonstrate accomplishments.

  • Developing consistent goals and objectives for the Hospital and the Pathologists.


Performance based part a what it is1
Performance Based Part A - What IT IS

IT IS:

  • Formulas that reward specific benchmarks.

  • A methodology that evolves as circumstances change.

  • A system that assures an effective balance so that both the Hospital and the Pathologists will mutually benefit from improved results.


How to proceed
How To Proceed?

Performance Incentives might be a new concept for both parties

Present a variety of options in line with Hospital priorities.

Select incentives that present an opportunity for an ongoing dialogue.

Review the items being measured and modify goals each year.

Assign a value to each component that is either a fixed amount or a % of savings/improvements.

Define the baseline and criteria for change.


How to proceed1
How To Proceed?

  • Present items that can be easily quantified and determine the source to be used:

    Finance Reports, Department LIS, Practice Billing Data for date of service

  • Include items that need to be accomplished as part of the Short/Long Term Goals of the Lab.

  • Establish a Department Development Fund as the beneficiary of some incentives

    “25% of savings to Practice and 25% to the Department Fund”

    (the other 50% retained by the hospital)

  • If the incentive is more difficult to achieve in a subsequent year, the payment should be increased. (assume the bar will continue to be raised)








Part a fact book
Part A Fact Book

  • Part A & RCE Calculation (Medicare Reasonable Compensation Equivalent ) 2004

    Metro < 1m = $219.5k

    Metro >1m = $215.7k

    Non-Metro = $208k

    This is the “average” compensation

  • History of Part A Payments

  • Time Study Summary

  • Average Part A Hours

  • RCE Calculation

    • $219.5 (2004) @ 3% Inflation = $295 (2014)

      + CME $5,000

      + Malpractice $15,000 (Actual)

      = $315k / 2,080 hrs. = $151.60

  • Medicare Published RCE Documents

  • Part A Calculation


Part a fact book1
Part A Fact Book

  • Time Study Documentation

  • Department Responsibilities

  • Committees

  • Detailed Time Study Worksheet

  • Minimum 4 weeks per year

  • Maximum 2 weeks per quarter

  • Customize the format

  • Matrix of Responsibilities (Pages 11-12)

  • Department Organizational Chart

  • Goals & Objectives

  • List of Committees by Pathologist

  • List of PA Committees (if paid by Practice)




Part a fact book2
Part A Fact Book

  • Part A Services

  • Current Contract

  • Annual Dept. Report

  • Comparative Data

  • Description of Part A Services (customized for your Hospital)

  • Agreement for Pathology Services Contract

  • Annual Laboratory Quality / Department Report

  • Press Ganey Scores

  • Average Weekly Part A Hours - Chief

  • Average Weekly Part A Hours – Associates

  • Current Part A as a Percentage of Calculated Part A

  • Medicare Cost Report Schedule A-8-2

    FOI Request


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