The Evolution of the Physician Compensation Plan: Volume to Value

1. 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

2. Today’s Business Compensation Plans Salary Salary plus Bonus Salary plus Bonus minus Expenses Salary plus Bonus minus Overhead

3. Today’s Production Compensation Plans 100% Production Salary plus Production Production RVU Clinical Time Encounters Administrative Time

4. 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 !

5. 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

6. 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

7. 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

8. 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

9. Rating and Comparisons CAHPS Survey For internal benchmarking to database…. at present. http://www.cahps.ahrq.gov/clinician_group/cgsurvey/patientexperiencemeasurescgsurveys.pdf

10. 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

11. 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.

12. 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

13. Exhibit 1. Physician Performance on PQRS Quality Measures in 2011

14. Exhibit 5. 2011 Total Per Capita Costs for Specific Services for the [#] Patients Whose Care You Directed

15. 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

16. MGMA DataDive

17. 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%

18. Physician Compensation

19. Models

20. 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

21. Value Compensation Models Bonus structure Carrot and stick Team goal rewards Citizenship credit Cost efficiency goals and QRUR scores Levels for: • met • exceeded

22. 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 !

23. Questions?