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9/1/14 UNDERSTANDING HEALTHCARE FINANCIAL MANAGEMENT Chapter 3 -- Payments to Providers PROBLEM 1: PLEASE SHOW WORK: Sunnyvale Primary Care (SPC) is considering a P4P program
9/1/14 | UNDERSTANDING HEALTHCARE FINANCIAL MANAGEMENT | ||||||||||
Chapter 3 -- Payments to Providers | |||||||||||
PROBLEM 1: PLEASE SHOW WORK: | |||||||||||
Sunnyvale Primary Care (SPC) is considering a P4P program to increase preventative care for its | |||||||||||
diabetic patients. HbA1c is a blood test used to determine how well diabetes is being controlled. The | |||||||||||
state medical association recommends that diabetic patients have this test a minimum of two times per | |||||||||||
year. In addition, because patients regularly enter and leave primary care practices, the association | |||||||||||
considers that a level of 90 percent of diabetic patients having a HbA1c test two times per year is a | |||||||||||
reasonable goal for most primary care practices. In the state where SPC is located, currently only 80 | |||||||||||
percent of diabetic patients actually have a HbA1c test two or more times per year. | |||||||||||
SPC decided on HbA1c as a process measure for its P4P program and is now considering three | |||||||||||
methods of allocating rewards. For each of the measures below, a physician receives a $5,000 bonus if: | |||||||||||
- the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater | |||||||||||
than the state average of 80 percent (relative performance). | |||||||||||
- the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater | |||||||||||
than the state goal of 90 percent (benchmark performance). | |||||||||||
- the difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year | |||||||||||
compared to the previous year is greater than 10 percent (improvement performance). | |||||||||||
The percent of diabetic patients that had at least two HbA1c tests in the past year for each SPC physician | |||||||||||
is shown below: | |||||||||||
Physician | Jan-Jun | Jul-Dec | |||||||||
A | 60% | 76% | |||||||||
B | 70% | 81% | |||||||||
C | 80% | 81% | |||||||||
D | 90% | 91% | |||||||||
a) For the Jul-Dec period, what would be each physician's P4P if rewards were allocated based on | |||||||||||
relative, benchmark, and improvement performance? | |||||||||||
b) Which method(s) of allocating rewards would you recommend? | |||||||||||
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