Pay for Performance

Quality
• Increasingly, we are being measured on
the quality of care and service we provide

• Measures are being made public to allow

the public to use quality data in making
decisions about their providers

• Reimbursement is starting to be tied to

measures of quality
 Efficient use of Resources
• Cost of health care has been spiraling out of
control
– Impacts economy and business viability
– Impacts ability of government to sustain public
programs
– Impacts access to care

• Interfaith’s financial sustainability depends upon:

– Productivity and control of our costs/visit
– Performance of our CHPW pools
 Pay for Performance
• Requires clarity about performance measures
that are key to organizational success

• Requires feedback to staff about their

performance on critical measures

• Allows celebration of success and opportunity

for performance improvement when problems
exist
 Pay for Performance
• Ties step increases and incentive bonuses
to performance measures critical to
organizational success
 Conceptual Draft
• Each position will have clear performance
measures specific to their duties

• Staff will be rank ordered on each performance

measure of quality of care and service.
– First Quartile (poorest) receives a -1
– Second Quartile receives a 0
– Third Quartile receives a 1
– Fourth Quartile receives a 2
 Conceptual Draft
• Satisfaction with wait time in clinic
• Satisfaction with wait time to get appointment
• Satisfaction with telephone service
• % of hypertensives in control
• % of diabetics in control
• % of children fully immunized
• Visits/FTE above or below benchmark
• % of prescriptions that are generic
 Conceptual Draft
• Scores for each staff member will be summed.
– Negative Number: no incentive pay or step increase,
performance improvement plan established
– Score of 0 to 1: receive established step increase.
50% of incentive pool payout
– Score of 1 to 1.5: receive 150% of established step
increase. Receive 75% of incentive pool payout.
– Score equal to or exceeding 1.5: receive 200% of
established step increase. Receive 100% of incentive
pool.
 Incentive Pool
• Annually, productivity levels will be
established that achieve a balanced
budget

• For visits above the established baseline,

variable revenue exceeding variable costs
will be established.
 Incentive Pool
Medical Clinic Example

• 30% reserved by Interfaith for its

development
• 20% forms a bonus pool for providers
• 20% forms a bonus pool for MA/RNs
• 20% forms a bonus pool for other clinic
staff
• 10% forms a bonus for admin staff
 Incentive Pool
Medical Clinic Example

• Variable revenue minus variable cost is about

$90/visit

• If benchmark is 3500 visits and provider team

does 4000 visits/year:
– incentive pool would be $45,000
• $13,500 reserved for development of Interfaith
• $ 9,000 reserved for provider contingent on quality
• $ 9,000 reserved for MA/RN teams
• $ 9,000 reserved for Other Clinic Staff
• $ 4,500 reserved for Admin Staff
 Incentive Pools
• Scores calculated and payments made on
a quarterly basis