Magnus Family Health Care, Essay Example

Magnus Health Care operates several family-practice physicians’ offices. In an effort to determine the value of utilizing pay-for-performance incentive structures, Magnus is launching a pilot Pay-for-Performance program at one location, with an eye towards implementing similar pay-for-performance initiatives at all five of its locations. Once fully implemented, the Magnus P4P Program will have an impact on employees and management at all levels, from senior management to individual office managers, office staff, physicians, medical assistants, and all other personnel directly employed by Magnus. This packet of information describes the rationale for Magnus Health Care to embrace a pay-for-performance approach, andexplains how the program will specifically affect all Magnus employees.

Background

Pay-for-performance (hereafter P4P)structures are being adopted in business in all different sectors. Such programs vary according to the specific needs and requirements of a particular business or industry sector, but all share the same basic ideology: that strong performance is incentivized and rewarded (Gibbs, 2012). The health care industry in the United States has been among the sectors wherein P4P has been widely embraced, especially as the policies and guidelines of the Affordable Care Act (ACA) have begun to come on line (Health Affairs, 2014). Much of the functions of the ACA operates through Medicaid and Medicare, and the new mandates ofthe ACA establish expectations and standards of performance from physicians and hospitals (Kaiser Health News, 2014). The typical Medicare reimbursement policy was based on a fee-for-service model, wherein physicians, health care providers, and hospitals were reimbursed for the provision of approved services. This model, according to critics, incentivized physicians and organizations to order tests, treatments, and other services based more on reimbursement rates than on patient care and outcomes (Leland, 2013).Under the ACA, Medicare and Medicaid are moving towards a “Value Based Purchasing” model, where patient outcomes and patient satisfaction scores provide the necessary metrics for determining reimbursement rates (Kaiser Health News). The move away from fee-for-service and towards fee-for-performance will not happen overnight, but it does mark a notable trend line in the health care industry.  As a provider of services to hundreds of patients insured through ACA exchanges, Medicare, and Medicaid, Magnus Health Careis taking steps towards implementing P4P models at all levels of the organization. Among the primary considerations for Magnus as this process of change takes place is that all employees are treated fairly, and that the focus of everything we do remains where it belongs: on our patients. With these issues and concerns in mind, the short-term implementation of Magnus Health Care’s new P4P program will not replace our current pay structures, but instead will augment them with bonus awards based on performance metrics. Bonus systems will be implemented for all employees based on their particular roles in the organization. The following sections provide an overview of how the new Magnus Heath Care P4P system will function.

Patient Satisfaction

At al Magnus Health Care locations, the patient is paramount. Positive health outcomes and positive experiences for our patients are two key factors in determining the overall quality of care provided by our facilities. Patients seeking health and medical care at our facilities have opportunities to meet and interact with office receptionists, office staff and managers, medical assistants, and physicians. It is the responsibility of every individual to provide the best possible level of care to all our patients. In order to assess patient satisfactionrelated to office visits, all patients will be asked to complete a satisfaction survey that assesses the quality of their experience and their interaction with staff.  The results of these surveys will be used to generate patient satisfaction scores, which will in turn be tied to bonus structures for members of the staff. These bonus structures will be discussed I more detail in subsequent sections.

Patient Outcomes

The quality of patient care is measured both by patient satisfaction and by the rate of positive patient outcomes. Patient outcome can be measured across a wide range of metrics, from the results of specific procedures or treatments to general improvements in health benchmarks such as blood pressure rates, blood sugar levels, weight measurements, number of follow-up appointments related to specific health care issues and a variety of other factors. The standard adopted by Magnus HealthCare is based on the model put forth by the ACA, which determines reimbursements rates based on a wide range of criteria. While not all (or even most) of the patients at Magnus Health Care facilities are covered by ACA-related insurance, the metrics used under ACA guidelines will be adopted as the de facto standard for satisfaction and outcome for all Magnus patients. In short, higher rates of patient satisfaction and positive health-related outcomes will translate into bonuses and rewards for all members of the Magnus Health Care organization.

Magnus P4P Work Group Structure

In order to develop P4P incentives that reward all employees appropriately and commensurate with performance as individuals and team members, the P4P structure will be divided into several distinct work groups. These groups will include senior management at Magnus Health Care, and location-specific management, office staff, physicians, and medical assistants. Because the members of each of these groups operates according to varying pay structures (ranging from salaries with bonuses to specified hourly rates), the rewards systems will be shaped to fit each group. While reimbursement rates from ACA, Medicaid, and Medicare are largely tied directly to physician performance, we recognize that no physician can do his or her best without a strong support team and effective management. With this in mind the P4P pilot program focuses on the physician as the locus of a larger network of individuals and groups that must each strive to deliver the best care to all of our patients.

Physicians

Under the extant system, physicians at Magnus are paid a base salary and are rewarded with a bonus structure based around the standard fee-for-service model. As positive health outcomes have always been a priority at Magnus Health Care, the fee-for-service model has not underpinned a tendency to provide unnecessary tests or treatments. Instead, the focus has always been on providing care that achieves the best possible outcome for every patient. Under the new P4P structure, Magnus Health Care physicians will continue to receive their standard salaries as specified in their individual contracts. The bonus and incentive structures, however, will now be tied to the Value Based Purchased model adopted by the ACA. The metrics used to determine positive outcomes (as described in previous sections) will serve as the basis for the new bonus structure. While the details of the ACA Value Based Purchase structure are too large to fit into this information packet, the basic premise of the new system is that positive short- and long-term patient outcomes are rewarded. This approach will allow Magnus Health Care physicians to focus only on what serves the patient best, rather than what sort of tests, treatments, or procedures are reimbursed at the highest rates.

Medical Assistants

Most patients at Magnus Heath Care facilities will spend more time and interact more regularly with our staff of medical assistants than with employees in any other work group. It is vital that medical assistants provide the best possible level of care to all patients, that they gather complete medical histories, and that they get up-to-date information on health data, such as blood pressure readings, body temperature, details about any symptoms the patient is experiencing, and other relevant information. By having all of this information at hand, the medical assistant prepares the physician to provide effective and complete service to each patient. Because medical assistants at Magnus Health Care work as a team, the teams at each location will be rewarded as a tea for providing excellent service.  Determinations for bonus and incentives will be made using metrics comprised of data from patient satisfaction surveys and the same patient-outcome data that underpins physician bonuses. Benchmark scores for patient satisfaction will established for each location, to be assessed and revised as needed on an annual basis. Members of the medical assistant work group will be rewarded for meeting and exceeding these benchmarks. This team-centric approach is intended to encourage cooperation among all members of the team.

Office Management and Staff

Because members of the office staff work group have the least direct contact with patients, their bonus incentives will be based on matrices that include data related to patient satisfaction, patient outcomes, and number of patients seen per day. Members of this work group will also be rewarded as a team, with percentage-of-salary-based bonuses given based on meeting or exceeding established benchmarks. This incentivizes both management and staff to work as a coordinated team, rather than incentivizing managers at different rates than support staff.

Senior Management

Like the physicians at all Magnus locations, most members of the senior management staff already work under a pay-plus-bonus plan of some sort. As a for-profit organization, Magnus Health Care has established bonus structures that reward management for strong financial performance of the organization. This system will remain in use, theough it will be modified to include satisfaction- and outcome-based matrices as well. In this manner, members of the management team will be stakeholders in positive patient outcomes along with the members of the other work groups.

References

Gibbs, M. (2012). Design and implementation of pay for performance.

Health Affairs – Health Policy Briefs,. (2014). Pay-for-Performance. Retrieved 8 August 2014, from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78

Kaiserhealthnews.org,. (2014). Interactive Chart: Bonuses And Penalties For U.S. Hospitals – Kaiser Health News. Retrieved 8 August 2014, from http://www.kaiserhealthnews.org/stories/2012/december/21/value-based-purchasing-chart.aspx

Leland, K. (2013). Innovative ‘Pay for Performance’ Program Improves Patient Outcomes | ucsf.edu.Ucsf.edu. Retrieved 8 August 2014, from http://www.ucsf.edu/news/2013/09/108776/innovative-%E2%80%98pay-performance%E2%80%99-program-improves-patient-outcomes