Practices are looking for ways to bring in supplemental income. And Pay for Performance (P4P) programs have developed as a way to reward health care providers for demonstrating achievement of performance goals.
Sage recently hosted a webinar focused on P4P programs where a panel of experts discussed participation in and benefits of several such programs including Bridges to Excellence, PQRI and the HITECH provisions of the Economic Stimulus plan.
Here are some details about those programs and some tips to help you get started.
If you are interested in participating in a P4P program Bill Henderson, webinar round table participant and Practice Administrator for Upstate Neurology Consultants, suggests these helpful tips to get you started:
Research
- Decide which types of programs you’re interested in, such as employer-based programs like Bridges to Excellence, or Federal programs such as PQRI and the HITECH provisions of the Economic Stimulus Plan.
- Contact your major, local insurers and inquire about P4P programs that they sponsor. Discuss all types of options: E-prescribing, use of Electronic Health Records (EHRs), quality initiatives, and specialty incentives for certain performance measures. Check back in with them every six months or so, since insurers roll out new programs periodically.
- Contact local groups in your community to see if any have been involved successfully in any P4P programs. This could provide you with leads for local programs that may be available to your practice.
Prioritize
- Distinguish between programs that do ‘physician profiling’ and those that do true P4P. The former usually doesn’t involve incentives other than directing patients to your practice by incentivizing them to use approved providers.
- Contact your specialty society and use their resources to see what they recommend as quality measures to use or for other’s experience with these programs.
- Be aware that not all specialties have measures for P4P programs. This situation may change in the future.
Evaluate
- Consider the measures for success that your practice will use to determine the success of program participation. Keep in mind that if initial experiences with P4P programs don’t result in additional funding, it may prepare the practice to ‘ramp up’ for future initiatives.
- Realize that if your group chooses not to participate in certain P4P measures, your practice may be penalized in the future.
Program overviews
The following programs were discussed during the Making P4P Work for Your Practice webinar. If you weren’t able to attend the webinar or missed a portion of it, you can still watch the recorded version.
Bridges to Excellence (BTE) – According to its website, BTE programs are designed to provide incentives that reward physicians and practices for adopting better systems of care that result in physician practice reengineering, the adoption of health information technology and delivering good outcomes to patients.
Physicians and their office practices are eligible to receive BTE program rewards if they:
- Play the role of primary caregiver for BTE eligible patients as identified by Bridges to Excellence based on physician to patient attribution data supplied by the participating health plans on behalf of participating purchasers.
- Demonstrate high levels of performance in BTE program content areas by obtaining passing scores on Performance Assessment Organizations' (PAOs) physician performance measures programs.
For specifics on this program visit www.bridgestoexcellence.org.
Physician Quality Reporting Initiative (PQRI) – PQRI is a voluntary reporting program that provides an incentive payment to identified Eligible Professionals (EPs) who satisfactorily report data on quality measures for covered Physician Fee Schedule services furnished to Medicare Part B Fee-for-Service beneficiaries.
For 2009, EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0% of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).
For specifics on this program visit:
HITECH provisions of the Economic Stimulus plan – The American Recovery & Reinvestment Act makes special provisions for physicians accepting Medicare and Medicaid through the HITECH Act, which appropriates $19.2 billion to encourage healthcare organizations to adopt and utilize Electronic Health Records.
The bill provides an even higher payment ceiling for "early adopters," defined as physicians who first begin "meaningful use" of HIT systems in 2011—the first year payment incentives will be available—or 2012. These physicians could receive as much as $18,000 the first year they adopt the technology. For example, if such a physician's allowed charges in 2011 or 2012 total $24,000 or more, he or she would receive the full $18,000 bonus that year.
View chart of annual HITECH Act incentives
Ready to get started?
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