NYC system unveils P4P plan; doc union wary

Just months after the CMS launched its value-based purchasing program, the nation's largest public hospital system has announced its own pay-for-performance project, which will tie physician bonus payments to patient-satisfaction scores, readmission rates and other metrics.

Fourteen-hospital New York City Health and Hospitals Corp. said the program will award up to a total of $59 million in incentives over three years to its 3,500 affiliated physicians.

The public system has negotiated contracts containing the pay-for-performance program with its affiliate physician groups at the Icahn School of Medicine at Mount Sinai, the New York University School of Medicine and the Physician Affiliate Group of New York, who together constitute the majority of the health system's treating doctors.

But the initiative could be held up by ongoing negotiations with the Doctor's Council SEIU, a union that represents many of the physicians affected by the program.

The union has taken issue with several of the program's 13 performance metrics, a Doctor's Council spokeswoman said. For instance, the union has balked at a measure aimed at reducing triage-to-admission times in emergency departments. Such a measure doesn't take into account the role of other hospital staff, including housekeeping and nursing, in ensuring beds are available when needed, the spokeswoman said.

The union has also emphasized that readmission rates for special-needs patients, such as the homeless, should be accounted for differently than for other patients.

The pay-for-performance program would also peg physician incentive payments to physician-patient communication, average lengths of stay and on-time starts for surgery, among other measures.

“The new bonus payments are directly linked to clinical and leadership activities where physicians can have the most impact,” said Alan Aviles, the health system's president, in the release. “By setting these improvement targets and awards, we more actively focus and facilitate the collaborative work necessary to render better care and while also shoring up the financial viability of our system going forward.

The Physician Affiliate Group of New York, which includes more than 2,000 physicians, stands to benefit the most from the pay-for-performance program. The group is set to receive $31.3 million, or just over half the total projected incentive payments over the next three years, to be awarded among physicians based on performance. Physicians at Mount Sinai and NYU will receive $13.75 million and $14 million, respectively.