UnityPoint Clinic s Value Based Compensation Pilot

Transcription

1 UnityPoint Clinic s Value Based Compensation Pilot Jessica Meisner, Vice President of Human Resources & Education Jessica.meisner@unitypoint.org Kyla Routson, Director of Physician Compensation Kyla.routson@unitypoint.org 1

2 UnityPoint Clinic Overview 2

3 UnityPoint Clinic-Senior Affiliate (UPC-SA) 3

4 UnityPoint Clinic Introduction UPC-SA Key Statistics 2015 Projected by 2017 Employees 2,600 5,000 Physicians and Providers 984 1,400 Clinic Locations Unique Patients Served Prior Year Projected Annual Net Patient Revenue 527,046 1 million+ $295 million $600 million 4

5 UnityPoint Clinic Introduction UPC-Specialties/Subspecialties Family Medicine Geriatrics Neonatology Rheumatology Internal Medicine Neurology Sleep Medicine OB/GYN Neurosurgery Sports Medicine Pediatrics Occupational Medicine Surgery Primary Care Orthopedics Orthopedic Surgery Hospital Medicine Palliative Care Bariatrics Infectious Disease Pediatric Cardiology Psychiatry Urgent and Express Care Allergy Physical Medicine & Rehab Otolaryngology Cardiology Interventional Invasive Electrophysiology Physical Therapy Diabetes Education Podiatry Wound Spine Intervention ENT Pulmonology Dermatology Gastroenterology Radiology 5

6 UnityPoint Clinic Introduction UPC Integration Across UPH Unity Point Health System Regional Affiliates (Hospitals) Unity Point Clinic Unity Point At Home Central Iowa Cedar Rapids Quad Cities Waterloo Sioux City Madison Fort Dodge Peoria Dubuque 6

7 UnityPoint Clinic Current State 7

8 UPC Compensation Plan Overview Physicians Production Plans Non Production Plans Time Based & Hospitalist Advanced Practitioners Production Plans General Production, High Intensity, OB/Gyn, Midwives, PhD Psychologists Salary Plans Clinic Based & Hospital Based 8

9 UPC Compensation Plan Overview 9

10 UPC Compensation Plan Overview Other Key Components Annual Rebasing Process The comp plans (tiers & rates) are updated annually based on national benchmark data The UPC Comp Committee oversees this process Biannual Recalculation Process Individual physician and provider salaries are recalculated twice a year based on most current 12 months work wrvu production January 1 salary: based on Jan 1 Dec 31 wrvus July 1 salary: based on July 1 June 30 wrvus 10

11 2016 Physician Production Plans Primary Care Family Medicine (without OB) Internal Medicine Pediatrics OB/Gyn General Internal Medicine Pediatric Urgent Care/Express Care Surgery Surgery: Foot & Ankle Surgery: Bariatric Surgery: General Surgery: Neurological Surgery: Orthopedic General Surgery: Vascular Cardiology Cardiology: Electrophysiology Cardiology: General Non Invasive Cardiology: Invasive Interventional Cardiology: Invasive Cardiology: Nuclear Echo Other Specialties Allergy/Immunology Dermatology Endocrinology/Metabolism Gastroenterology Infectious Disease Nephrology Neurology OB/Gyn Urogynecology ENT Pain Management/Anesthesiology Physiatry (PMR) Psychiatry General Pulmonary Medicine General Rheumatology New for 2016 Family Medicine (with OB) Urology Surgery: Cardiothoracic Surgery: Plastic & Reconstruction Pain Management: Non-Anesthesiology 11

12 2016 Physician Non-Production Plans Shift Based Models Hospitalist Plans Pulmonary Medicine: Crit Care/Intensivist Time Based Models Infectious Disease Pulm Crit Care/Intensivist Float Primary Care Physicians Float Primary Care Advanced Practitioners 2016 Advanced Practitioner Plans General Production Plan High Intensity Production Plan Internal Medicine Cardiology Diabetes & Endocrinology Pulmonology OB Gyn Production Plan Midwife Production Plan PhD Production Plan Clinic Based Salary Plan Hospital Based Salary Plan 12

13 UnityPoint Clinic Pilot 13

14 Primary Care Physician Model Old Model Current Model Future Model - Pilot 100% Production 12% (wrvus) Value Based Performance 33% Value Based Performance 88% Production (wrvus) 33% Production (Panel Size, wrvus) 33% Base Salary 14

15 Pilot Plan 15

16 Pilot Plan Selection Criteria 4 Family Practice pilots were selected PCMH sites preferred Clinics with varying levels of production and/or value based performance Includes an effective spokesperson to share results of the pilot 16

17 Value Based Compensation Pilot Compensation Compensation for all providers will be protected for the duration of the pilot January 1 recalc becomes salary guarantee throughout the year At year end*, each provider will be paid the greatest of: January Recalc Year end compensation calculation (2016 Plan) Value Based Comp** If the pilot is not successful, comp protection will be provided for 1 year following pilot end 17

18 Primary Care Physician Model Concepts Future Model - Pilot Median producers with median quality will earn median cash compensation; opportunity to go up to P75 with median panel and excellent quality Considerable income opportunity for taking larger panel sizes (or generating RVUs within those panels) and maintaining/increasing VBP with the same level of downside for production/quality below average Increased productivity cannot come at the expense of decreased quality 33% 33% 33% Value Based Performance Production (Panel Size, wrvus) Base Salary 18

19 Comp Plan Design Base Salary Fixed amount based on national market median Provider survey indicated a strong desire to incorporate a base salary component into a future model 33% 19

20 Comp Plan Design Production Defined as both wrvus (half or 17%) and Panel Size (half or 17%) Fixed amount per panel member Fixed amount per wrvu wrvus remain in the model wrvus account for panels with varying levels of acuity Reflects an environment where fee-forservice and value-based reimbursement are both present Provider survey indicated a strong desire to keep wrvus in the model 33% wrvus Panel Size 20

21 Comp Plan Design Production Panel size definition will be important Ability to risk adjust will be critical Appropriate panel size will be reflective of your specialty Installing tools that provide various ways to precisely measure clinical & individual provider panels 33% wrvus Panel Size 21

22 Comp Plan Design Value Based Performance Plan is flexible and metrics will evolve over time based on our value based contracts Like today, plan will be reviewed and assessed annually to incorporate appropriate, fair & meaningful metrics Future plan may look very different than it does today & could include things like Quality, Patient Satisfaction, PMPM and Utilization Management Quality Committee to discuss appropriate blend of clinic level vs individual accountability 33% 22

23 Comp Plan Design Value Based Performance Categories & Weightings Performance Criteria Weight Opportunity Patient Experience 20% 6.6% Financial Performance 20% 6.6% Quality 35% 11.55% Care Coordination 15% 4.95% Citizenship 10% 3.3% TOTAL 33% 23

24 Value Based Compensation Pilot Metrics Production (wrvus) Patient Experience Provider Satisfaction Clinical Financial Performance Quality & Care Coordination *Referral Tracking is calendar year Panel Size Access (Third Next Available) Quarterly (rolling 12 mos) Quarterly (calendar year) At Year End - Did it work? - Did you like it? - Would you go back? - Satisfaction with Comp? At Year End - Key clinic ratios - Operating Margin Change - Staff cost/wrvu Quarterly (rolling 12 mos) - Consider removing 12 mo cumulative or calendar year metrics if applicable Quarterly (rolling 24 mos) Quarterly 24

25 Operational Implications Areas of Focus Operational changes needed/staffing models Promote team based care Increased focus on Quality Increased focus on Patient Experience Access for panel members 25

26 Primary Care Physician Model Example 1 Family Practice Physician Average Producer Average Quality Goal: Median producers with median quality will earn median cash comp P50 = $210,000 26

27 Primary Care Physician Model Example 2 Family Practice Physician Average Producer Excellent Quality Goal: Median producers with excellent quality will earn P75 cash comp P75 = $265,000 27

28 Primary Care Physician Model Example 3 Family Practice Physician Low Producer Excellent Quality P25 = $175,000 28

29 Primary Care Physician Model Example 4 Family Practice Physician High Producer Low Quality P50 = $210,000 29

30 Primary Care Physician Model Example 5 Family Practice Physician High Producer High Quality P90 = $325,000 30

31 What has happened so far 31

32 Compensation Committee February 9, 2016 Value Based Compensation Pilot Key Themes High levels of engagement Initial operational opportunities The role of the AP Panel concept dominates conversation 32

33 Compensation Committee February 9, 2016 Value Based Compensation Pilot Initial Operational Opportunities PCMH Refresher Chart Prep/Gaps in Care Dedicated time for Staff to work Quality reports Purposeful focus on Quality EPIC Assistance Dedicated focus on Patient Experience 33

34 Compensation Committee February 9, 2016 Value Based Compensation Pilot The Role of the AP Independent providers, team support, or both? Is it appropriate to incorporate panel into the AP comp plan? Source of contention, source of competition Concern about how this impacts attribution 34

35 Compensation Committee February 9, 2016 Value Based Compensation Pilot Panel Concept Current Definition Attribution not currently limited to PCP 35

36 Compensation Committee February 9, 2016 Value Based Compensation Pilot Panel Concept Initial Provider Feedback Question Phys Response AP Response Overall Avg On a scale of 1 10, how accurately do you feel this represents your true panel of patients? 1 = does not represent my panel at all 10 = represents my patient panel perfectly My panel is: A lot larger than I expected A little larger than I expected About what I expected A little smaller than what I expected A lot smaller than what I expected On a scale of 1 10, how comfortable would you feel if this attribution definition & panel method (as it stands today) were to be incorporated into the compensation calculation?

37 Compensation Committee February 9, 2016 Value Based Compensation Pilot Panel Concept Individual vs Clinic level panel (Competition) Concern about protecting my panel and preventing dilution Stifles team based care Access concerns The PSRs can only schedule my patients with me It s not worth $5-7 for me to see a patient that isn t mine OUR patient vs MY patient Don t disrupt the equilibrium we ve reached for co-sharing patients 37

38 Compensation Committee February 9, 2016 Value Based Compensation Pilot Panel Concept Definition revision & general discovery Database clean up (retired, term d and non-upc providers) Extend time frame from 24 months to 36 months? Add Nursing Home E&M CPTs? Should patients be attributed to: Urgent Care? Specialists? APs? Other Concerns History isn t always reflective of the future List includes deceased & term d patients, patients who have moved Distribution between APs and Physicians 38

39 Compensation Committee February 9, 2016 Value Based Compensation Pilot Conclusions We do not yet have our attribution definition right, and there s still work to do to refine it 39

40 Questions? 40