Value-Based Physician Compensation and Dashboards

Transcription

1 MGMA 2017 ANNUAL CONFERENCE OCT ANAHEIM, CA Value-Based Physician Compensation and Dashboards Kameron McQuay, CPA/ABV, CVA Director, Blue and Co. LLC Indianapolis, Ind. MGMA has determined that Kameron McQuay has a financial interest in consulting. The content of this session has been reviewed and has been determined not to be a conflict of interest. 1

2 Learning Objectives Evaluate contemporary physician compensation program designs related to valuebased incentive plans Grade the most effective and reasonable quality metrics currently being utilized in the healthcare industry today Assess current trends in physician dashboards and alternative feedback systems Changing ment Models Shared Savings Global ments All services compensated in one payment that manages the patient across the delivery system Percentage of savings from reduced cost of care shared with hospitals and physicians Bundled ments Single payment for episodes of treatments, shared by hospital and physicians Value-Based Purchasing Percentage reimbursement at risk, earned back by high quality outcomes -For- Performance Incentives for higher quality measured by evidence-based standards Fee-For-Service Providers paid a specified amount for each service provided 2

3 Some Ideas for Change Current Approach Suggested Approach Blue Approach 100% Targeted Compensation/wRVU 70% Targeted Compensation/wRVU 25% Quality and Group Incentives 5% 90% Targeted Compensation/wRVU 10% Quality and Group Incentives 0% ment Models Are Changing *Pre-MACRA wrvus Rate per wrvu Compensation *Post-MACRA 10% wrvus 15% 50% Compensation 25% Quality Advancing Care Information Clinical Practice Improvement Activities Resource Use 3

4 Compensation Model wrvus CF Base Professional Fees (Fee for Service) ACO Income Call Coverage Patient Satisfaction Third Party er Initiatives Non-productive Incentives are embedded Quality into overall model Capitation Fees Meaningful Use Extra s: NP Supervision Additional Call Coverage Attribute Key Indicators in Compensation Plans Mean % Utilized 2010 Mean % Utilized 2016 wrvu s 79% 64% Quality 8 15 Patient Satisfaction 5 8 Service Excellence 4 5 Strategic Goals 3 3 Citizenship 1 3 Access % 100% 2016 Average wrvu Productivity= 85% 2018 Estimated Average wrvu Productivity = 80% 4

5 Compensation Practices Base Salary Work RVUs ment Models Are Changing *Pre-MACRA wrvus Rate per wrvu Compensation *Post-MACRA 10% wrvus 15% 50% Compensation 25% Quality Advancing Care Information Clinical Practice Improvement Activities Resource Use 5

6 What Will Determine My MIPS Score? A single MPS composite performance score will factor in performance in 4 weighted performance categories on a scale Merit-Based Incentive ment System (MIPS) Overview 6

7 MIPS: 2017 Score Components Improvement Activities 15% Advancing care info (EHR use) Quality 60% Merit-Based Incentive ment System 7

8 EXHIBIT A TO PHYSICIAN EMPLOYMENT AGREEMENT FOR Dr. John Doe primary care physician The following Quality Indicators shall be used to determine whether or not incentive compensation will be paid to Physician and, if so, what amounts. For each Quality Indicator for which Physician meets or exceeds the threshold Physician shall earn One Thousand Dollars ($1,000). Quality Indicators: 1. Timeliness of patient appointments from time in the door to time out the door. The threshold is set at Sixty (60) minutes. If Physician s average is 60 minutes or less for the year, he will receive $1, Length of time for patients to get appointments with Physician. The threshold is set at 48 hours. If Physician s average is Forty Eight (48) hours or less for the year, he will receive $1, Health/Wellness. Physician shall recommend and see that certain diagnostic tests and/or procedures are completed for patients in certain age groups as suggested by the authorities in the medical profession and/or as required by regulators. Examples include pap smears, mammograms, A1C blood tests, colonoscopies, and more. The threshold is set at 90% of patients to be directed to obtain these types of tests, and Physician s documentation must state so. If at least 90% of patient charts show such documentation by Physician, where applicable, Physician shall receive $1, Management of Obese Patients. Physician shall see that proper testing, follow-up, treatment, and education to patients for self-management are documented in the patient records as applicable. The threshold is 90%. If Physician manages at least 90% of such patients appropriately, he shall receive $1, Management of newly diagnosed high risk patients. Physician shall see that proper testing, follow-up, treatment, and education for patients concerning their new diagnoses are documented in the patient records. The threshold is set at 90%. If Physician manages at least 90% of such patients as appropriate, he shall receive $1, Timeliness of appropriate prescription refills. Medication refills that must be called to a pharmacy are to be completed within Twenty Four (24) hours of the patient s request for the refill. If the average length of time it takes for patient medication refills is 24 hours or less, he shall receive $1,000. EXHIBIT A - CONTINUED 7. Timeliness of completing documentation after each patient visit. The threshold is Five (5) business days. Physician to receive $1,000 if completed on time.hysician shall receive $1, Response time to being contacted by hospital personnel and/or other physicians and providers. The threshold is one hour from receipt of the contact, be it voic or text message. If the average length of time it takes Physician to respond to a message is 60 minutes or less, Physician shall receive $1, Wellness for pediatric patients. Physician shall recommend and see that childhood immunizations are offered to pediatric patients at the recommended ages and intervals. The threshold is 100%. If Physician recommends and documents those recommendations 100% of the time for pediatric patients throughout the year, Physician shall receive $1, ICD Coding. Physician shall comply with the requirements for ICD 10 coding. The threshold is 90%. If throughout the year, Physician provides necessary documentation for at least 90% of the patient records so that ICD 10 requirements are met, Physician shall receive $1, Patient satisfaction. Physician shall maintain patient satisfaction scores above an average of 90% for the year, and Physician shall receive $1,000 for accomplishing this. 12. Tobacco cessation. Documentation by Physician shall include that patients are screened at least once in 24 months and that patients have received cessation counseling by Physician in same time period. Documentation threshold is 90%, and if achieved, Physician shall receive $1, Body Mass Index. For any abnormal BMI for patients Physician shall document appropriate follow up for a minimum of 90% of the time for such patients. Documentation shall apply to follow up for BMIs less than 23 and shall address nutrition and intervention, and for BMIs greater than 30 to address exercise and diet counseling. If metric is achieved Physician shall receive $1, Pneumonia vaccinations. Physician s documentation must show that patients 65 years of age and older received the pneumonia vaccine or medical reasons that they have been excluded. The threshold is 100% and, if met, Physician shall receive $1, Depression. Physician shall document screening for depression and any follow up plan every 12 months. Assessment scoring tool must be used, which shall show either presence or absence of depression, and Physician must document a follow up plan or must document any special instructions and/or exclusions for each patient. The threshold is 90%. If threshold is met or exceeded, Physician shall receive $1,000. These Quality Initiatives are hereby agreed upon by Physician and Employer.. 8

9 Suggested Approach to Compensation Targeted Comp/wRVU Ratio wrvu Productivity 70% Quality and Individual/Group Performance Incentives 25% 5% Blue Approach to Compensation Targeted Comp/wRVU Ratio wrvu Productivity 85-90% Quality and Individual/Group Performance Incentives 10% 9

10 Physician Compensation in a Value-Based Environment Challenges How do we define value and what types of behavior are we going to reward? By putting more physician dollars at risk, how do we maintain competitive wages for our physicians? In rewarding value, what s the proper distribution between incentives and penalties? With 90%+ of our reimbursement still FFS, how do we pay for value when we are not getting paid for value? What percentage of total compensation should the incentive or withhold represent? How do I measure a return on our technology investments to track value and how doimanageallthis data? With so many quality measurements, how do I pick which attributes to monitor? 2016 Cardiology Preferred Specialty Measure Set 10

11 2016 General Practice/Family Practice Specialty Measure Set Cardiology Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low Risk Surgery Patients Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI) Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low Risk Patients Care Plan Closing the Referral Loop: Receipt of Specialist Report Controlling High Blood Pressure Coronary Artery Disease (CAD): Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%) Coronary Artery Disease (CAD): Antiplatelet Therapy Coronary Artery Disease (CAD): Beta Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) Documentation of Current Medications in the Medical Record Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up Plan Preventive Care and Screening: Screening for High Blood Pressure and Follow Up Documented Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Tobacco Use and Help with Quitting Among Adolescents 11

12 General Practice/Family Medicine Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy Avoidance of Inappropriate Use Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse) Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use) Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse) Adult Sinusitis: More than One Computerized Tomography (CT) Scan Within 90 Days for Chronic Sinusitis (Overuse) Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users Anti Depressant Medication Management Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Breast Cancer Screening CAHPS for PQRS Clinician/Group Survey Care Plan Cervical Cancer Screening Colorectal Cancer Screening Controlling High Blood Pressure Coronary Artery Disease (CAD): Beta Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) Depression Remission at Twelve Months Diabetes: Eye Exam Diabetes: Foot Exam Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) Diabetes: Medical Attention for Nephropathy General Practice/Family Medicine Cont. Documentation of Current Medications in the Medical Record Documentation of Signed Opioid Treatment Agreement Elder Maltreatment Screen and Follow Up Plan Evaluation or Interview for Risk of Opioid Misuse Falls: Plan of Care Falls: Risk Assessment Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis HIV Viral Load Suppression Immunizations for Adolescents Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet Medication Management for People with Asthma Non Recommended Cervical Cancer Screening in Adolescent Females One Time Screening for Hepatitis C Virus (HCV) for Patients at Risk Opioid Therapy Follow up Evaluation Optimal Asthma Control Osteoarthritis (OA): Function and Pain Assessment Osteoporosis Management in Women Who Had a Fracture Pain Brought Under Control Within 48 Hours Persistence of Beta Blocker Treatment After a Heart Attack Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up Plan Preventive Care and Screening: Influenza Immunization Preventive Care and Screening: Screening for Clinical Depression and Follow Up Plan Preventive Care and Screening: Screening for High Blood Pressure and Follow Up Documented Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Tobacco Use and Help with Quitting Among Adolescents Tuberculosis (TB) Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older Use of Imaging Studies for Low Back Pain 12

13 General Surgery Anastomotic Leak Intervention Care Plan Closing the Referral Loop: Receipt of Specialist Report Documentation of Current Medications in the Medical Record Patient Centered Surgical Risk Assessment and Communication Perioperative Care: Selection of Prophylactic Antibiotic First OR Second Generation Cephalosporin Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up Plan Preventive Care and Screening: Screening for High Blood Pressure and Follow Up Documented Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Surgical Site Infection (SSI) Tobacco Use and Help with Quitting Among Adolescents Unplanned Hospital Readmission within 30 Days of Principal Procedure Unplanned Reoperation within the 30 Day Postoperative Period Some Ideas for Change Begin with a cultural revolution Create a physician compensation committee Tackle primary care compensation first Focus on patient centered medical care 13

14 Compensation Redesign Overriding Principles Program to be sustainable Compensation is to be market based and fair Goal is not to reduce physician compensation from historical levels Metrics are to be reasonable and measurable Components may include: Financial performance Clinical Quality Service Quality (including access and population management) Patient satisfaction Strategic/Mission goals Citizenship/teamwork Efficiency and cost of care All criteria must align with organizational goals Must meet regulatory requirements Health System 1 Productivity 85% Quality Diabetes 3 Quality Tobacco 1 Quality Chronic Care 1 Patient Satisfaction 5 Patient Access 3 EHR Documentation 2 100% Health System 2 Productivity 80% Quality Preventative 5 Quality ACO Criteria 5 Same Day Visit % 5 Meeting Attendance 5 100% 14

15 Mirror-Based Compensation wrvu s 8,000 Conversion Factor $ 50 wrvu s 8,000 Conversion Factor $ 40 Quality Incentive Total Compensation $405,000 $400,000 $5,000 $320,000 Quality Incentive (20% of Compensation) Service Quality 35% Clinical Quality 50% Citizenship 10% Legacy 5% Total Compensation $400,000 $80,000 Proposal Compensation Plan Primary Care 85% 5% 5% 5% Production wrvu Based 3 Comp. Bands Based on Median -MGMA -AMGA - Sullivan Cotter Total Prior Year Comp. Factored Clinical Quality 90% Completion Rate for Wellness Visits Diabetes A1C Mgmt. One Individual Goal Service Quality New Patients Seen by Physicians Urgent Care Scheduling Patient Satisfaction score > 50 th Percentile Stakeholder Criteria 8 hours/month of Organizational Service 100% Attendance at Provider Meetings Budget Targets for Ambulatory Network 15

16 Employed Provider Performance Dashboard InflowHealth Dashboard 16

17 Continuing Education ACMPE credit for medical practice executives. 1 AAPC All except CIRCC and CPMS credit. 1 ACHE credit for medical practice executives 1 CME AMA PRA Category 1 Credits.. 1 CNE credit for licensed nurses 1 CPE credit for certified public accountants (CPAs) 1.2 CEU credit for generic continuing education 1 Let the speakers know what you thought! Evaluations are available on the MGMA mobile app Kameron McQuay kmcquay@blueandco.com Blue and Co. LLC 500 N. Meridian St., Ste. 200 Indianapolis, IN