The program is significant not only because of HHC's size and presence in the region, but also because it could motivate other public hospitals and systems to follow suit, experts say.
“I think it's a good model that will have implications for the whole marketplace,” said Dr. Bruce Siegel, president and CEO of the National Association of Public Hospitals and Health Systems. “It's a sign of things to come, and I expect that now that one large system has taken the plunge, others will follow.”
It's not the first time a hospital has entered into an incentive program with physicians, Siegel said. But past agreements have usually included one physician group or a single department, such as cardiology. “We've never seen anything this comprehensive,” he said.
The initiative has been in the works for more than a year, when negotiations began with HHC's three affiliate physician groups: the Physician Affiliate Group of New York, the Mount Sinai School of Medicine and the NYU School of Medicine.
Past contracts with the groups always included routine cost-of-living increases, but those pay hikes were absent this time around. Alan Aviles, HHC's president, argued such automatic increases are no longer financially feasible.
“If we provide any additional compensation for physicians, it has to be derived by new revenues generated or losses avoided,” he said.
HHC patterned its pay-for-performance program on the CMS' value-based purchasing program and readmissions reduction program, both of which launched in October. For instance, HHC included measures such as physician-provider communication and discharge instructions for heart-failure patients.
Also, the health system tied a portion of each affiliate's bonus payments to whether HHC retains its Level 3 designation under the National Committee for Quality Assurance's Patient-Centered Medical Home Recognition Program.
Each of the three affiliate groups' contracts contains a slightly different set of measures, based on negotiations. But they draw from a basic list of 13. PAGNY is set to receive $31.3 million over the next three years, while physicians at Mount Sinai and NYU will receive $13.75 million and $14 million, respectively.
The program is structured to help HHC stay out of the penalty range on both CMS programs, no easy feat for a public system with a tight budget and a large population of poor and uninsured patients. Aviles acknowledged that physicians weren't happy about losing their cost-of-living increases, but he said they weren't surprised.
“They are mission-driven and they understand the tremendous fiscal pressure faced by safety net providers,” he said.
Dr. Jasmin Moshirpur, dean of the Icahn School of Medicine at Mount Sinai, agreed that physicians were expecting such changes. She also predicted that most doctors could meet the program's targets fairly easily, although she said recent events such as superstorm Sandy and the influenza outbreak could make that more difficult on some measures, such as emergency department triage-to-admission times.