Incenting Physicians to Improve the Patient Experience

Tuesday, May 17th, 2011
This post was written by Jessica Fornarotto

Practices that exceed patient satisfaction metrics will be rewarded at bonus time, explains Bruce Nash, MD, MBA, senior VP of medical affairs and CMO for Capital District Physicians’ Health Plan Inc. (CDPHP).

Our bonus model is $50,000, and we based it on the Institute for Healthcare Improvement (IHI) Triple Aim. We are looking for improved satisfaction, and we want improvements in value, quality and cost.

We approach satisfaction by dealing with it as a threshold measure. If the practice drops below a certain level, they are not eligible for the bonus at all. It is an important safeguard if one is going to move to a mostly capitated type of payment, because every payment model has its own perverse incentives. We want to make sure the patients are receiving an appropriate experience.

As a health plan, when it came to creating the approach for the quality and cost pieces, in order for this to be sustainable and scaled, we needed to be sure that measurements in those areas that we were rewarded on resulted in savings to the plan, because otherwise we wouldn’t achieve our goals. Therefore, we created this idea that by hitting your quality metrics, you created the bonus opportunity. However, you didn’t earn it unless you hit the efficiency metrics. We chose 18 specific Healthcare Effectiveness Data and Information Set (HEDIS®) measures along the line. We are not trying to say these are the ‘be all and end all,’ but we do have a scoring methodology. These 18 measures get scored on a grid. It is weighted, and depending on how they do compared to last year, they end up with an overall score. Our overall score at a particular practice hit 66.9 percent of the $50,000. Each physician created an opportunity for $33,448 of bonus payments.

As we look at efficiency, we are an Ingenix® client. Our efficiency model is based on a customized version of an efficiency score. We are comparing everybody to the overall network. It is a relative model that we are using. Any practices in the top 10th percentile would be eligible to earn the full $50,000, if they created that opportunity with their quality. If they are in the bottom 10th percentile, they are not eligible for a bonus. In between, we multiply the efficiency score times the bonus and add this in as a kicker for improvement year to year.

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