Pay For Performance

Pay for Performance

Quality • Increasingly, we are being measured on the quality of care and service we provide • Measures are being made public to allow the public to use quality data in making decisions about their providers • Reimbursement is starting to be tied to measures of quality

Efficient use of Resources • Cost of health care has been spiraling out of control – Impacts economy and business viability – Impacts ability of government to sustain public programs – Impacts access to care

• Interfaith’s financial sustainability depends upon: – Productivity and control of our costs/visit – Performance of our CHPW pools

Pay for Performance • Requires clarity about performance measures that are key to organizational success • Requires feedback to staff about their performance on critical measures • Allows celebration of success and opportunity for performance improvement when problems exist

Pay for Performance • Ties step increases and incentive bonuses to performance measures critical to organizational success

Conceptual Draft • Each position will have clear performance measures specific to their duties • Staff will be rank ordered on each performance measure of quality of care and service. – – – –

First Quartile (poorest) receives a -1 Second Quartile receives a 0 Third Quartile receives a 1 Fourth Quartile receives a 2

Conceptual Draft • • • • • • • •

Satisfaction with wait time in clinic Satisfaction with wait time to get appointment Satisfaction with telephone service % of hypertensives in control % of diabetics in control % of children fully immunized Visits/FTE above or below benchmark % of prescriptions that are generic

Conceptual Draft • Scores for each staff member will be summed. – Negative Number: no incentive pay or step increase, performance improvement plan established – Score of 0 to 1: receive established step increase. 50% of incentive pool payout – Score of 1 to 1.5: receive 150% of established step increase. Receive 75% of incentive pool payout. – Score equal to or exceeding 1.5: receive 200% of established step increase. Receive 100% of incentive pool.

Incentive Pool • Annually, productivity levels will be established that achieve a balanced budget • For visits above the established baseline, variable revenue exceeding variable costs will be established.

Incentive Pool Medical Clinic Example

• 30% reserved by Interfaith for its development • 20% forms a bonus pool for providers • 20% forms a bonus pool for MA/RNs • 20% forms a bonus pool for other clinic staff • 10% forms a bonus for admin staff

Incentive Pool Medical Clinic Example

• Variable revenue minus variable cost is about $90/visit • If benchmark is 3500 visits and provider team does 4000 visits/year: – incentive pool would be $45,000 • • • • •

$13,500 reserved for development of Interfaith $ 9,000 reserved for provider contingent on quality $ 9,000 reserved for MA/RN teams $ 9,000 reserved for Other Clinic Staff $ 4,500 reserved for Admin Staff

Incentive Pools • Scores calculated and payments made on a quarterly basis