Saving Fee For Service The feasibility of a proposed hospitalbased physician group remuneration model

Natalie Clavel, MD, FRCPC, MHSc(c) Toronto Western Hospital – UHN [email protected]

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Outline 1. Physician Remuneration 2. The Problem 3. Proposed Remuneration Model 4. Methods /Analysis 5. Results / Discussion 6. Conclusion / Next Steps

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Accountability to Stakeholders

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Public Scrutiny

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Value for Money We can do your job for less … and maybe better !?!

Targeted Drug Delivery Systems

Nurse Practitioners FRCPC

Respiratory Therapists Anesthesia Assistants

Specialists Physician Assistants

Family Physicians

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Accountability to MD Group  Non-Clinical Time

 Teaching  Tough cases  Attendance  Late rooms  On call  Committees / Engagement  Clinical Competency 6

Objectives

 Characterize group and individual MD practice and performance at a large academic Anesthesia Department  Create a publically disclosed MD performance scorecard that satisfies and consolidates ALL deliverables required from MDs by key STAKEHOLDERS and strategically aligns GROUP outputs  Leverage the existing Fee For Service MD remuneration model by placing 10% of elective FFS billings “At Risk”, using a MD performance scorecard  Quantitative and qualitative assessment of resulting remuneration scheme

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Remuneration Model(s) “Engagement & Performance Tax”

“AT RISK”

GROUP POOL

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ANESTHESIA SCORECARD PROFESSIONAL

25%

PHYSICIAN DELIVERABLES

BENCHMARK

RESULTS

Attendance (business / educational / academic) CME 360 Evaluation Strategic Benchmarks (corporate / Departmental / QIP) BIling (audits / payments / administration)

> 80% Up To Date Same or > Performance > 90% Compliance > 90% Compliance

86% UTD Improved 92% 84%

ITEMS COMPLETED CONTRIBUTION TO “AT RISK” POOL

CLINICAL

50% ENGAGEMENT

25%

EBM / Clinical Guidelines (premeds/ antibx. / temp) SIMS (documentation) OR Flow (anesth time / PACU time) Clinical Outcomes (pt vitals / pt satisfaction / readmission) Quality and Patient Safety (Sx Pause / PSLS) Clinical Skills (simulator / CPSO) PGME / UGME (clinical supervision / teaching)

EDUCATION ADMINISTRATION RESEARCH ENGAGEMENT

>95% Compliance >90% Compliance >85% Compliance >80% Compliance >95% Compliance Meets Expectations >80% Student Satisfaction

4/5

5% 97% 92% 80% 86% 99% Meets 85%

ITEMS COMPLETED CONTRIBUTION TO “AT RISK” POOL

7%

>80% Completion of Deliverables >80% Completion of Deliverables >80% Completion of Deliverables >50% Completion of Items

76% 92% 0% 90%

ITEMS COMPLETED CONTRIBUTION TO “AT RISK” POOL

1/2

% OF “AT RISK(10%)” INDIV. CONTRIBUTION RETAINED BY GROUP

6/7

12.5%

24.5%

Group Pool Allocation Schemes GROUP POOL

Revenue-neutral

Incentive-based

MD 1 MD 2 MD 3 “At Risk” pool divided equally among individual physicians

MD 1 MD 2 MD 3 70% 80% 90% “At Risk” pool distributed equitably to reflect scorecard performance

Revenue Generating (Tax)

GROUP FINANCIAL POT “At Risk” pool used to fund / incentivize strategic outputs / initiatives 10

Methods – Data Collection  REB Approval / Department Consent  Review of Anesthesia Department billing sheets for period of October 16, 2013 to November 15, 2013 at the Department of Anesthesiology, General Campus, The Ottawa Hospital care care

Exclusion criteria for patient encounters : care provided by physician employed