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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

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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
Today’s Business Compensation Plans

Salary

Salary plus Bonus

Salary plus Bonus minus Expenses

Salary plus Bonus minus Overhead

today s production compensation plans
Today’s Production Compensation Plans

100% Production

Salary plus Production

Production

RVU

Clinical Time

Encounters

Administrative Time

quality cost value
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 !

today s compensation plans should be strategic
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
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

emerging quality benchmarks
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

emerging quality benchmarks1
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

rating and comparisons
Rating and Comparisons

CAHPS Survey

For internal benchmarking to database…. at present.

http://www.cahps.ahrq.gov/clinician_group/cgsurvey/patientexperiencemeasurescgsurveys.pdf

payer designated quality
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

ncqa provides physician quality assistance
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.
value based reimbursement
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

slide13

Exhibit 1.

Physician Performance on PQRS Quality Measures in 2011

slide14

Exhibit 5.

2011 Total Per Capita Costs for Specific Services for the [#] Patients Whose Care You Directed

slide15

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

quality and satisfaction
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%
value compensation models
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

value compensation models1
Value Compensation Models

Bonus structure

Carrot and stick

Team goal rewards

Citizenship credit

Cost efficiency goals and QRUR scores

Levels for:

  • met
  • exceeded
use the models that enhance quality cost value
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 !