The Evolution of the Physician Compensation Plan:

Volume to Value

Todd Evenson, MBA Vice President of Consulting Services and Data Solutions,

MGMA-ACMPE

MGMA 2013 ANNUAL CONFERENCE

Today’s Business Compensation Plans

SalarySalary plus Bonus

Salary plus Bonus minus ExpensesSalary plus Bonus minus Overhead

© 2013 MGMA/ACMPE. All Rights Reserved.

Today’s Production Compensation Plans

100% ProductionSalary plus Production

ProductionRVUClinical Time EncountersAdministrative Time© 2013 MGMA/ACMPE. All Rights Reserved.

Quality + Cost = ValueQuality in 3 Main areas:

• Clinical Quality

• Quality of the Patient Experience

• Quality of Outcomes

All areas with the emphasis on lowering costs !© 2013 MGMA/ACMPE. All Rights Reserved.

Performance

Time

Today’s Compensation Plans Should Be Strategic

Transition to Value-based Payment

FFS Value

Strategy strives to maintain trajectory

-Quality-Satisfaction-Outcomes-Shared Savings

Making the move toward value…

Current quality benchmarks:

Consumer: healthgradesAngie’s List Word of MouthPractice 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

© 2013 MGMA/ACMPE. All Rights Reserved.

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=dvpvdrUsed by permission of Michael V. Jackson, MD

© 2013 MGMA/ACMPE. All Rights Reserved.

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

© 2013 MGMA/ACMPE. All Rights Reserved.

Rating and Comparisons

CAHPS Survey

For internal benchmarking to database…. at present.

http://www.cahps.ahrq.gov/clinician_group/cgsurvey/patientexperiencemeasurescgsurveys.pdf© 2013 MGMA/ACMPE. All Rights Reserved.

Payer Designated Quality

Aetna Aexcel®

www.aetna.com/plans-services-health-insurance/detail/assets/documents/Member-brochure.pdf

Cigna Provider Excellence Recognition Directorywww.cigna.com/healthcareprofessionals/resources-for-health-care-professionals/health-and-wellness-programs/quality-initiatives.html

United Premium® Physician Designation Programwww.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Unitedhealth%20Premium/UnitedHealth_Premium_Detailed_Methodology_2012.pdf

Medicaid

Accountable Care Organizations© 2013 MGMA/ACMPE. All Rights Reserved.

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.

© 2013 MGMA/ACMPE. All Rights Reserved.

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

© 2013 MGMA/ACMPE. All Rights Reserved.

PQRS Measure Number

Clinical Condition and PQRS

Measure Specifications for PQRS clinical measures are posted at

http://www.cms.gov/PQRS/Downloads/2011_PhysQualRptg_MeasuresList_033111.pdf

PQRS Performance

You

All PQRS Participants

Nationwide

Number of

Cases You

Reported

Performance

Rate for Cases You Reported

Number of

Participating Physicians Reporting

Cases

Mean Performance

Rate

Diabetes Mellitus (DM) Measures Group

1 DM: Hemoglobin A1c Poor Control in Diabetes

Mellitus

% %

2 DM: Low Density Lipoprotein (LDL-C) Control in

Diabetes Mellitus

3 DM: High Blood Pressure Control in Diabetes Mellitus

117 DM: Dilated Eye Exam in Diabetic Patient

119 DM: Urine Screening for Microalbumin or Medical

Attention for Nephropathy in Diabetic Patients

Exhibit 1.

Physician Performance on PQRS Quality Measures in 2011

© 2013 MGMA/ACMPE. All Rights Reserved.

Service Category

Medicare Patients Whose Care You

Directed

Average for Medicare Patients Whose Care Was Directed by [#] Physicians in Your Specialty in the

Nine States

Amount by Which Your Medicare

Patients’ Per Capita Costs Were Higher

(or Lower) than Average

Your Medicare Patients Using Any Service in This

Category

Total Risk-

Adjusted Per

Capita Costs

Medicare Patients Using Any Service in This Category

Total Risk- Adjusted Per Capita Costs

Number Percentage Number Percentage

All Services 100% $ 100% $ $/($)

Evaluation and Management Services in All Non-Emergency Settings

Provided by YOU for Your Patients % $ % $ $/($)

Provided by OTHER PhysiciansTreating Your Patients

Procedures in All Non-EmergencySettings

Provided by YOU for Your Patients Provided by OTHER PhysiciansTreating Your Patients

Hospital Services (ExcludingEmergency Outpatient)

All Hospital Services Inpatient Hospital Facility Services Outpatient Hospital FacilityServices

Emergency Services That Did NotResult in a Hospital Admission

Exhibit 5.

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

© 2013 MGMA/ACMPE. All Rights Reserved.

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

© 2013 MGMA/ACMPE. All Rights Reserved.

MGMA DataDive

Quality and Satisfaction

• 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%

data/mgma.com/ptsat

Physician Compensation

Salary Salary + RVU Value0

1

2

3

4

5

6

7

8

9

10

Patient SatisfactionOutcomesPQRSRVUSalary

© 2013 MGMA/ACMPE. All Rights Reserved.

Models

Value Value Value 0

1

2

3

4

5

6

7

8

9

10

healthgradesPhysician ComparePayersNCQACAHPSEHR UseQRURRVUSalary

© 2013 MGMA/ACMPE. All Rights Reserved.

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 RVUsEHR use = 500 RVUsGood internal CAHPS scores = 300 RVUs

© 2013 MGMA/ACMPE. All Rights Reserved.

Value Compensation Models

Bonus structureCarrot and stickTeam goal rewardsCitizenship creditCost efficiency goals and QRUR scores

Levels for: met exceeded

© 2013 MGMA/ACMPE. All Rights Reserved.

Use the Models that EnhanceQuality + 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 !© 2013 MGMA/ACMPE. All Rights Reserved.

Questions?