VOLUME 2 - ISSUE 15
JANUARY 19, 2012



Welcome to the Pay for Performance Update eNewsletter
This issue sponsored by the Pay for Performance Summit



8 Misconceptions About the Physician Quality Reporting System
Although the CMS' Physician Quality Reporting System -- formerly the Physicians Quality Reporting Initiative -- has been in existence for five years, confusion persists about this voluntary pay-for-performance program that pays an incentive to eligible physicians who comply with quality measures for services provided to Medicare fee-for-service patients. John Haughton, MD, lists out eight misconceptions about this program. (Becker's Hospital Review - January 13, 2012)

HealthEdge Survey Shows Payers Planning to Support New Healthcare Models, Including Pay-for-Performance
More than 50 percent of the 106 payer respondents said their organizations are prepared to support payment reforms including accountable care organizations (54.4 percent) and pay-for-performance (50.5 percent), as well as broader and undefined "other healthcare reform initiatives" (64.1 percent) and "other models involving new payment approaches" (51.5 percent). (Healthcare Finance News - December 27, 2011)

Hospital Value-Based Purchasing Program: An Introduction for Anesthesiologists
Medicare's Value-Based Purchasing (VBP) program for hospitals, mandated by the Affordable Care Act, took off upon the release of final regulations on April 29, 2011. VBP marks the start of true pay-for-performance, as opposed to pay-for-reporting, at the hospital level. The intent is to pay for better value, patient outcomes and innovations, and not simply to reward volume of services. (Becker's Orthopedic, Spine and Pain Management Review - January 4, 2012)

Questionable Perks Given to Ontario Hospital Executive Through Pay-for-Performance Bonus, Contracts Reveal
Dr. Robert Howard, president and CEO of St. Michael's Hospital, receives an annual base salary of $450,000, a year-end supplement worth 17 per cent of his base salary and a 5 per cent pay-for-performance bonus. Howard also receives a $75,000 travel allowance to be used for the purchase or lease of a car, with St. Mike's paying for gas, car insurance, maintenance fees and a space in the hospital's lot. In addition, Howard accepted an annual pension top-up of $100,000, which the hospital offered as an incentive for him to stay on as CEO; the payments began April 2009 and will end April 2014. (thestar.com - January 4, 2012)

VHA Inc. Leverages Unmatched Gainsharing, Analytics and Consulting Expertise to Help Health Care Systems Make Sense of Bundled Payments and Pay-for-Performance
As U.S. hospitals and health care systems prepare for health care reform and the transition from "pay for service" to "pay for performance," most organizations are evaluating how various new reimbursement models, including bundled payments, will affect their long-term financial viability. To help health care systems test their readiness, assess their savings opportunities and analyze their claims data for potential bundles and payments, VHA Inc., the national health care network, is leveraging its 35 years of experience helping hospitals and health systems realize greater cost effectiveness, plus its 16 years experience in hospital-physician alignment consulting -- including the expertise of the industry's only true gainsharing model approved by the Office of Inspector General -- to provide systems with a complete Bundled Payment Solution. (MarketWatch - January 10, 2012)

Pioneer ACOs Promoting Pay-for-Performance to Ring in the New Year
Pioneer ACOs will lead the charge in changing how providers are paid, moving away from the traditional fee-for-service system to a pay-for-performance approach that rewards quality over quantity. Launching even sooner than the Medicare Shared Savings Program, the Pioneer ACOs are just that, pioneers, and leaders in the healthcare revolution. (FierceHealthcare - December 22, 2011)

Hospital Perspectives on Reducing and Preventing Readmissions Highlight Complexity of Pay-for-Performance Schemes
Although hospital executives grappling with the readmissions challenge report interest in pay-for-performance arrangements, applying this incentive structure across the care continuum presents its share of challenges. Many organizations still have a long way to go before they develop the sophisticated understanding and modeling of costs and risk across care settings that will best support adoption of a physician-hospital bundled payment structure. Although 38 percent of those responding to the HFMA survey report they feel ready for value-based payment, only a small percentage say they are "prepared" (12 percent) or "very prepared" (1 percent) for bundled payment. (InsuranceNewsNet - December 23, 2011)

How Do I Know What My Data Are Telling Me?
All too often the complexity of a system requires us to rely on an information technology person or "power user." That individual actually performs one or more queries in the database or system files and delivers the data to us in Excel so we can manipulate it and format it to meet our needs for presentation. As providers rely more and more on EHRs, they'll be faced with the same tasks whether we report on meaningful use objectives and measures or the next iteration of pay for performance and accountable care organizations. (MedPageToday - December 29, 2011)





American Academy of Family Physicians' Pay-for-Performance Guidelines

The American Academy of Family Physicians (AAFP) recognizes the need to reform physician payment, including pay for performance as one approach. However, there are a multitude of organizational, technical, legal and ethical challenges to designing and implementing pay for performance programs. The AAFP also recognizes that there are both advantages (increased payment, improved efficiency and quality) and disadvantages (cost of acquiring information technology, multiple programs and guidelines, data collection) to such programs as they are currently designed and implemented. Payers' physician measurement processes used to rate/designate family physicians should be transparent and adhere to the AAFP policy on Performance Measures Criteria, Physician Profiling, Data Stewardship, and Transparency.


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Keynote Address: A Framework for Payment Reform

James C. Robinson, PhD
Leonard D. Schaeffer Professor or Health Economics, University of California at Berkeley, Director, Berkeley Center for Health Technology, Berkeley, CA