In July 2008, the Medical Group Management Association released the results of a questionnaire that ranked members most pressing practice-management challenges. In this edition of Practice Makes Perfect, we tackle No. 11 on that list: Participating in commercial pay-for-performance programs.
Commercial P4P programs are broad and varied in scope. Not all health plans offer a program; some that did have discontinued them. Nonetheless, leaders of every medical practice should be aware of P4P programs offered by the plans with which they contract. Even if a health plan doesnt offer a program, it may reward participation in external quality-improvement initiatives such as NCQA (National Committee for Quality Assurance) Physician Recognition.
Initially, health plans focused on programs that encouraged lower costs by managing use of healthcare services. Insurers often used the number-of-bed-days-per-1,000-plan enrollees as a common measure. Today, the majority of P4P programs focus on quality metrics, such as the percentage of patients in a certain age group receiving screening colonoscopies.
Here are basic guidelines for a medical practice seeking to participate in a P4P program. Ensure that:
- Performance measures are reasonable, preferably established by evidence-based medicine from a recognized, relevant authority.
- The program has multiple targets so the incentive doesnt depend on attaining only one quality factor.
- The incentives encourage physician participation and cover the administrative expense of participation.
- The incentives are in addition to the existing reimbursement plan, not just an opportunity to earn back funds withheld from contracted payments.
- The practice has the right and ability to audit and correct performance data. Many P4P programs are based on claims data, which can be inaccurate. Understand where the performance data will come from and how they will be measured.
- The health plan conducts frequent performance monitoring and reporting to physicians.
- The written agreement supporting the program is clear and detailed.
Jeffrey MilburnIndependent consultantMGMA Health Care Consulting GroupEnglewood, Colo. Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.