The right approach, such as annual bonuses for meeting quality measures, can help reluctant physicians embrace value-based payment models.
This article appears in the September 2015 issue of HealthLeaders magazine.
The healthcare industry is moving steadily toward value-based payments, but physicians tend not to be as far along in accepting the idea as C-suite executives. That can be a problem, because physician participation is key to meeting the population health goals that determine whether the health system makes money.
Some health systems are seeing success in getting physicians on board with the kinds of clinical changes that will be required by offering financial incentives, such as annual bonuses for meeting quality measures.
Robert Fortini, PNP
For the past year at Bon Secours Health System in Marriottsville, Maryland, physicians have been incentivized with the Primary Care Quality Incentive Program (PCQIP), a shared savings model that allows physicians to benefit from the system's work with accountable care organizations. Physicians traditionally were paid a base salary plus a productivity bonus, explains Robert Fortini, PNP, who is the chief clinical officer for Bon Secours Medical Group in Richmond, Virginia.
This year, Bon Secours—a $3.3 billion nonprofit Catholic health system with 19 acute care hospitals and operations in six states—added a quality incentive for primary care physicians and intends to roll out the same program to specialty physicians next year. The health system has participated in the Medicare Shared Savings Program for three years.
Under the new PCQIP program, physicians still can earn a productivity bonus because, after all, Bon Secours is still providing fee-for-service medicine, and volume matters. PCQIP also includes a financial gate, meaning physicians must meet their budgeted volumes before they can participate in PCQIP and try for quality bonuses.
"That was a rude awakening for a lot of physicians who never paid much attention to volume targets, and now they have to meet their budgeted target volumes to even be eligible for the quality bonus," Fortini says. "About 70% of our physicians are meeting their projected budget targets as well as quality indicators and are eligible for the quality bonus." The first bonus payout will be this fall.
More than quality measures
Each of the 250 physicians who met the volume threshold opted to participate in PCQIP and try for the quality bonus.
After passing that financial gate, they must meet the PCQIP requirements to get the quality bonus. The first is citizenship, meaning the physician must attend 75% of all meetings called by Bon Secours for compliance, clinical measures, and other important issues. The physician also must complete 100% of required training for topics such as infection control and HIPAA compliance.