Williamson-Chatman 3.23 Symposium
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Williamson-Chatman 3.23 Symposium

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3.23 OSMA Symposium presentation - Dr. Williamson and Dr. Chatman

3.23 OSMA Symposium presentation - Dr. Williamson and Dr. Chatman

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    Williamson-Chatman 3.23 Symposium Williamson-Chatman 3.23 Symposium Presentation Transcript

    • Clinical Integration and Quality Improvement Jay C. Williamson, M.D. CMO, Summa Physicians Inc. Robin Chatman, MD Trinity Family Medicine Copyright 2012Ohio State Medical Association 1
    • The Integrated Healthcare Delivery System Hospitals Physicians Health Plan FoundationInpatient Facilities Multiple Geographic Reach System Foundation• Tertiary/Academic Campus Alignment Options • 19 Counties for Commercial Focused On:• 3 Community Hospitals • Employment • 18 Counties for Medicare • Development• 1 Affiliate Community Hospital • Joint Ventures • 60-hospital Commercial • Education• 2 JV Hospitals with Physicians • EMR provider network • Research • Clinical Integration • 41-hospital Medicare • InnovationOutpatient Facilities • Health Plan provider network • Community Benefit• Multiple ambulatory sites • National accounts in • Diversity• Locations in 3 Counties Summa Physicians, Inc. multiple states • Government Relations • 260+ Employed Physician • AdvocacyService Lines Multi-Specialty Group 191,000• Cardiac, Oncology, Neurology, O Total Members rthopaedics, Surgery, Seniors, B Summa Health Network • Commercial Self Insured ehavioral • PHO with over 1,000 • Commercial Fully Insured Health, Women’s, Emergency, R physician members • Group Process Outsourcing espiratory • EMR/Clinical Integration • Medicare Advantage Program • Individual PPOKey Statistics• 2,000+ Licensed Beds• 62,000 Inpatient Admissions• 47,000+ Surgeries• 660,000+ Outpatient Visits Net Revenues: Over $1.5 Billion• 226,000+ ED Visits Total Employees: Nearly 11,000• 4,300+ Births• Over 220 Residents Copyright 2012Ohio State Medical Association 2
    • The Next Evolution of the Integrated Delivery System Summa fundamentally believes that accountability in healthcare is a moral imperative with Integration being a means to that end • We believe that the current healthcare payment system is unsustainable and that payment mechanisms will have to change to better align incentives toward reducing total healthcare costs while continuing to provide high-quality care • Summa will use its Integrated Delivery System to provide continually improving, value- based, high-quality, transparently accountable care to patients, populations and payers it serves • Summa will build upon its relationships to continually advance accountability by partnering in a deeper way with patients, populations, and payers toward improving the health of our communities while reducing costs Copyright 2012Ohio State Medical Association 3
    • Community Collaborations: Physician Joint Ventures• Summa Health Center at Lake Medina – Joint venture outpatient surgery center with 2 ORs and 1 procedure room opening in conjunction with the new Summa Health Center at Lake Medina development – Includes physicians from the following specialties: OB/Gyn, General Surgery, Pain, Podiatry, Ophthalmology, Hand• Summa Western Reserve Hospital – Joint venture started in June 2009 between Summa Health System and Western Reserve Hospital Partners – Began the for-profit Summa Western Reserve Hospital at the current Summa Cuyahoga Falls General Hospital location• Crystal Clinic Orthopaedic Center (CCOC) – Orthopaedic Hospital Joint venture between Summa Health System and Crystal Clinic (a local group of approximately 30 orthopedic surgeons) – Began operations in May 2009 on the Summa St. Thomas Hospital Campus Copyright 2012Ohio State Medical Association 4
    • Critical IssuesThree critical issues threatening the stability of today’shealthcare system:1. Uninsured and underinsured populations are increasing.2. Healthcare costs are escalating.3. Government regulations are expanding and government reimbursement is not keeping the pace with the cost of providing care. Copyright 2012Ohio State Medical Association 5
    • Summa Physicians Inc. Governance• 501(c) 3 organization• Independent Board of Directors which include physicians and senior management appointed by system governance committee• Oversee all aspects of SPI operations and finance except compensation• Physician Advisory Council to CMO• Both fully employed and leased models Copyright 2012Ohio State Medical Association 6
    • SPI Overview• 270 Physicians• 59 Advanced Practice Nurses and Physician Assistants• 671 non-Provider Employees• Summit, Medina, Portage, Wayne, and Stark• Physicians hired based on Community Need, Mission and preventing physician “leakage” from Summa• New planned growth to be based on System needs and focused strategic growth Copyright 2012Ohio State Medical Association 7
    • Satisfied, Engaged, and Aligned Physicians SPI Growth as of December 2011• Summa Physicians, Inc. continues to have success with its model for physician employment Number of Employed Physicians 300 255266 220 200 187 100 81 41 7 8 14 17 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Copyright 2012Ohio State Medical Association 8
    • SPI – Business Model• Physician Compensation is Productivity Based• Will soon be implementing a model looking at quality metrics, patient satisfaction and issues such as community service and System performance• Ancillary Services have transferred to Provider Based Billing under the Hospitals• Mission focus helps eliminate unnecessary System costs• All physicians are employed under a Hospital or System approved business plan• Reviewing Leased vs. Employed Model Copyright 2012Ohio State Medical Association 9
    • 2011 SPI ACCOMPLISHMENTS• Outstanding Budget – Performance through December $3.9 million better than budget.• Vast Improvement in health risk assessment – Over 1000 this year have been completed leading to better documentation of care provided to Medicare patients and enhanced reimbursement.• Our newly added 24 physicians• Outstanding performance in light of a year of transition featuring three different presidents in 2011.• EMR implementation with 113 providers and 37 doctors attested for Meaningful Use at $18,000 each and 15 more by year end which aids in care coordination and integration. Copyright 2012Ohio State Medical Association 10
    • The Future - SPI• Implement Strategic Plan – Enhance Physician Engagement and System Integration – Expand Market Penetration (selectively and strategically) and Increase our Patient Population – Achieve superior Operative and Clinical Performance – Improve Population Health through ACO and Medical Homes Copyright 2012Ohio State Medical Association 11
    • Patient Center Medical Home (PCMH) The Affordable Care Act Main ObjectivesFocus on Measurably Improving Population Health Meaningful Measures of System PerformanceOrganizational Accountability for Capacity, Cost and Quality Right WorkforcePayment for Value, Not Volume Healthy Consumer Overall Goal is to move healthcare cost from downstream to upstream Continued Preventable Health Condition ACO PCMH No Hospitalization Acute Care Episodes Successful High Cost Complications, Re Outcome Outcome admissions In order to achieve the objectives of reform, we need to transform our current delivery system from high cost, low value to low cost, high value through a strong primary care foundation Copyright 2012Ohio State Medical Association 12
    • PCMH Impact on Stakeholders Across Continuum CareBetter, safer, less costly, more Improved member and employerconvenient care satisfactionBetter overall health Lower costsProductive long-term relationship Opportunity for new business Payer modelswith a PCP Patient SpecialistsIncreased focus on thepatient and their health Better referralsGreater access to health Whole patient care integrationinformation Better follow upHigher reimbursement PCMHMore PCPs PCP Government Lower healthcare costs Healthier population Hospital EmployerLower number of chronic careadmissions and readmissions Lower healthcare costsIncreased focus on procedures. More productive workforce Improved employee satisfaction Copyright 2012Ohio State Medical Association 13
    • What is PCMH?A PCMH puts patients at the center of the health care system, and providesprimary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” Features of PCMH A personal physician who coordinates all care for patients and leads the team. Physician-directed medical practice – a coordinated team of professionals who work together to care for patients. Whole person orientation – this approach is key to providing comprehensive care. Coordinated care that incorporates all components of the complex health care system. Quality and safety – medical practices voluntarily engage in quality improvement activities to ensure patient safety is always being met. Enhanced access to care – such as through open-access scheduling and communication mechanisms. Payment – a system of reimbursement reflective of the true value of coordinated care and innovation. Copyright 2012Ohio State Medical Association 14
    • How Features of PCMH are Implemented?Enhanced Access Physician Directed Medical Practice Team Extended Hours, Open Schedule Team approach Internet, e-mail Low complexity tasks handled by otherIncreased same day access avoids ER andincrease continuity members of the team Team members can be internal/external Collaborative relationship between physician andQuality and Safety non-physician practitioners Evidence Based Medical care QI projects at the practice level Personal Physician & Whole Person Orientation First contact, continuous and comprehensive careCoordinated/Integrated Care Contextual Care Registries Proactive care Having a usual source of care is associated with a greater likelihood that people receive appropriate care, preventive Information Technology care, better outcomes, lower cost Health Information Exchange Chronic care coordination Internal/external care coordination Part of a patient’s health plan Reduced duplication and improved coordination across the spectrum of care Copyright 2012Ohio State Medical Association 15
    • Summa PCMH Pilot Project Roadmap Highlights of Project 6 practices involved IT and Policy Subcommittees PCMH Performance Metric Team SUMMA NCQA Recognition PCMH Transformation Transformation Cultural Change Redefining staffing roles Improve Outcomes NCQA Recognition Program Offered at three level–basic, intermediate and advanced Measure improvements Goal is to obtain Level 3 Support ACO Initiatives Publically report Gap Analysis achievements Identification of PCMH Metrics EHR Upgrades Policy Creation and Standardization Copyright 2012Ohio State Medical Association 16
    • PCMH• ACO paying for part-time physician leader, full- time analyst, and project director.• PHO will pay for NCQA Certification Fees. Copyright 2012Ohio State Medical Association 17
    • Accountable Care Organization Our ACO is a clinician-led care collaborative that partners with communities to compassionately care for and serve our populations in an accountable, value- and evidence-based manner.Organizational Facts• Start Date – Began operations January 1, 2011• Initial Pilot Population – 11,000 SummaCare Medicare Advantage members that currently see a participating primary care physician• Legal Entity – Non-profit taxable structure allows for physician majority on the Board• Board Composition – 4 community primary care physicians, 1 medical specialist, 1 surgical specialist, 3 Summa representatives Copyright 2012Ohio State Medical Association 18
    • PCMHPrimary Specialty Patients Hospital Skilled Nursing Home Ambulatory Home Care Care and ED Nursing Health Copyright 2012Ohio State Medical Association 19
    • Financials:PMPM Target and Results - 2011 Medical Spend Shared Savings PMPM Annualized Breakeven $793.62 $0 SC Medicare NHC ACO $733.79 $7,400,000 2010 Milliman Benchmarks Loosely Managed $752.45 $5,089,600Competitively Managed $639.56 $19,045,513 Well Managed $522.36 $33,534,246 Copyright 2012Ohio State Medical Association 20
    • Progress Milestones: 2011• Began Operations• Heart Failure Readmission Initiative• Heart Failure Education• Discharge-to-Home Care Transition Copyright 2012Ohio State Medical Association 21
    • Progress Milestones• Population-based Actuarial Analysis• ACO Finance Committee• ACO Clinical Value Committee• ACO Medical Home Initiative• Call Center Plan• Harmony Plan Copyright 2012Ohio State Medical Association 22
    • PHYSICIAN COMPENSATION PLAN Summa Physicians, Inc. (SPI) Copyright 2012Ohio State Medical Association 23
    • PHYSICIAN COMPENSATION PLAN• High Performance Team appointed in late 2011 by new SPI President to outline a new compensation model by early 2012.• Multispecialty group including representatives from the following areas: – Family Medicine – Psychiatry – Surgery (Colorectal) – Gastroenterology – Hematology / Oncology – Cardiology – General Internal Medicine – Geriatrics Copyright 2012Ohio State Medical Association 24
    • PHYSICIAN COMPENSATION PLAN• Began with weekly meetings with a goal for the new model to be part of new and updated contracts• Agreement for a one year “shadow” program to see how the model works• Outlined a set of Guiding Principles and an Incentive Plan Proposal was developed Copyright 2012Ohio State Medical Association 25
    • GUIDING PRINCIPLES SPI CMO COMPENSATION COMMITTEE GENERAL CONTRACTING PRINCIPLES1. All should share in the success of the organization.2. Incentive plan is calculated on 20% of base compensation. Base compensation is not reduced to fund incentive plan.3. A shadowing program will be used the first six months, the new system will start in 2013. Standardized contract language will be used with an agreed upon compensation plan.4. Incentive Dimensions required for all. Metrics include Success of SPI/Summa Health System, Citizenship, Information Management, Quality/Service. (Incentive Plan Proposal attached)5. Quality metrics for primary care and specialties are different and subgroups may be needed to work out details.6. Annual performance review required and passing review will be required to qualify for bonus distribution.7. Patient satisfaction review will be part of all metrics. One standardized survey will be used.8. Changes in base compensation are being considered.9. Incentives obtained from some bonus dollars and possibly ACO shared savings dollars.10. MGMA should remain the salary benchmark of choice.11. Blends of education, teaching, and work productivity will remain part of the contracts. Copyright 2012Ohio State Medical Association 26
    • INCENTIVE PLAN PROPOSALTARGET: TOP QUARTILE TOTAL POINTS = 20Incentive Dimensions: 2/6/12 Success of SPI / Summa Citizenship Information Management Quality / Service (Individual & Group)Growth of Established and Loyal Attendance @ SPI meetings Measures of Integration Access to Care – Same DayPatients - SPI ≥ 75% of meeting  Keep the patient @ home  Established Patient and  Information Management New Patient Major Conditional Incentive within NetworkSource: eCW counted charts, billings  In Network Use of Lab/ (1% Group)of unique patients during the prior ½ point Radiology/PT-Rehabyear vs. next year Source: Referral Tracking in eCW, Source: Phone survey for Source: Attendance sign in and lab/imagining/pt by ordering established and new patients 2 points sign out sheets monitored by physician SPI ops. 3points 2 pointsProfitability of Summa Hospital Completion of Records on a Measures of Coordination Inpatient SCIP & Core Measures atOperations / Meet or Exceed Budget timely basis  Hand off Measures 98% attainmentExpectations - Summa Hospital  Two-way Communication Major Conditional Incentive  Satisfaction withSource: Summa Financials, booked ½ point Referring Physicians Info Source: CMS/JCHAO List of Topyear end hospitals only  Collegiality / Stellar APR performers Source: eCW “closed files Source: Referral Sender/Receiver 2points report”, Med Records survey 3 points Procedures 3 pointsPatient Satisfaction > 75th percentile Inpatient patient satisfaction withSource: Press Ganey OP, C. Natale physicians above 50th percentile 2points Source: HCAHPS 2points 6 Dimensions of Quality (IOM) Safe Pt. Centered Effective Timely Efficient Equitable Copyright 2012Ohio State Medical Association 27
    • PHYSICIAN COMPENSATION PLAN• Further discussion by specialty of quality metrics Copyright 2012Ohio State Medical Association 28
    • Example of Quality Metrics for Diabetic Care inPrimary Care Practices B D E F G H I J K L M N O Eye Exam1 Insurer DOS HbA1c Date LDL Date Urine date Result BP Sys BP Dias Foot Exam CPT/ICD Date2 MC 7/9/11 6.4 7/19/11 59 3/22/11 N N 112 62 N N 250.00/2143 SC SEC 6/30/11 9.4 6/27/11 110 6/27/11 N N 150 67 5/5/11 N 250.00/2144 MC 3/22/11 7.3 3/16/11 94 6/16/11 1/21/10 Neg 115 49 9/2/01 N 250.00/2145 SC SEC 5/19/11 7.2 5/19/11 92 4/21/11 N N 149 75 N 8/16/10 250.00/2146 MC 3/30/11 10.9 8/15/11 73 8/3/11 N N 156 12 N 5/3/10 250.00/2147 MC 2/3/11 6.2 2/17/11 61 5/20/11 12/30/10 POS 153 74 N 12/20/10 250.41/2148 MC 7/22/11 6 7/15/11 High Trig 7/1/11 N N 146 63 11/10/11 N 250.00/2149 MC 7/11/11 7.5 6/9/11 67 6/9/11 N N 113 67 4/8/11 N 250.00/21410 MC 7/13/11 5.6 7/7/11 43 7/6/11 N N 129 61 N N 250.00/21511 MC 6/15/11 6.4 6/9/11 69 6/8/11 N N 117 62 8/2/11 N 250.00/21412 MC 4/19/11 8.4 4/19/11 74 1/11/11 4/19/11 Neg 140 102 N 5/11/11 250.02/20513 SC SEC 8/22/11 6.4 8/8/11 51 1/3/11 N N 150 85 8/1/11 N 250.00/21414 MC 8/18/11 6.6 10/18/10 83 1/10/11 1/10/11 Neg 133 61 4/11/11 N 250.00/21415 MC 8/17/11 7.3 8/10/11 160 8/10/11 N N 141 61 3/17/11 N 250.00/21416 MC 8/9/11 8.9 8/2/11 78 8/2/11 N N 144 68 11/18/10 N 250.02/21417 MC 2/1/11 6.5 1/26/11 78 1/26/11 N N 123 62 N N 250.00/21418 MC 3/25/11 6.8 3/9/11 59 6/15/11 N N 128 66 2/24/11 N 250.02/21419 MC 3/25/11 6.9 3/9/11 3/9/1900 3/9/11 9/15/10 Neg 126 73 N N 250.00/21420 MC 6/16/11 5.5 6/9/2011 42 1/25/2011 10/10/2011 Neg 124 3/3/1900 8/18/11 12/23/10 250.00/21421 MC 7/14/11 6.6 2/3/11 57 11/23/10 N N 128 65 4/27/11 N 250.00/214 Copyright 2012Ohio State Medical Association 29
    • Example of Quality Metrics for Diabetic Care inPrimary Care Practices B D E F G H I J K L M N O Eye Exam 1 Insurer DOS HbA1c Date LDL Date Urine date Result BP Sys BP Dias Foot Exam CPT/ICD Date22 MC 3/28/11 7.3 3/21/11 34 3/21/11 N N 140 85 N N 250.00/21523 MC 6/29/11 6.2 6/22/11 71 6/22/11 N N 138 80 3/4/11 N 250.00/21424 MC 7/11/11 6.9 7/5/11 51 3/2/11 N N 122 64 N N 250.00/21425 MC 5/4/11 6.2 4/13/11 89 4/13/11 N N 95 60 N N 250.00/21426 MC 7/27/11 5 7/20/11 126 7/13/11 7/13/11 POS 144 88 7/11/11 N 250.00/21427 MC 8/23/11 6.4 5/13/11 102 5/13/11 9/17/10 NEG 126 68 10/2/11 N 250.00/21428 MC 7/13/11 6.4 7/1/11 38 7/1/11 N N 123 66 9/8/10 2/11/11 250.00/21429 MC 6/22/11 5.9 6/15/11 83 6/15/11 3/7/11 POS 138 80 N N 250.00/21430 MC 8/23/11 7.1 8/16/11 76 6/14/11 N N 130 74 N N 250.00/21431 MMO MC 8/25/11 7.3 6/17/11 63 8/18/11 N N 138 78 1/11/11 N 250.00/21432 MC 2/1/11 5.8 1/4/11 55 1/4/11 N N 111 52 10/19/10 1/19/10 250.00/21433 MC 2/1/11 6.9 6/7/11 89 1/4/11 5/21/10 POS 134 64 2/3/11 1/19/10 250.00/21434 MC 1/5/11 6.5 3/2/11 87 12/30/10 N N 166 77 10/12/10 N 250.00/21435 MC 9/6/11 7.5 9/1/11 52 5/10/11 N N 120 79 8/11/11 N 250.00/21436 Anthem SR 6/15/11 6.5 6/7/11 56 6/8/11 N N 133 70 N N 250.00/21437 MC 5/11/11 7.8 5/4/11 104 8/4/11 N N 137 75 4/-/11 N 250.02/21438 MC 8/3/11 6.2 7/20/11 57 7/20/11 7/20/11 Neg 114 63 9/13/10 N 250.00/21439 MC 8/1/11 7.3 7/6/10 N N N N 150 96 1/20/11 N 250.00/20340 MC 6/29/11 6.1 7/2/10 67 7/2/10 N N 144 82 4/9/11 N 250.00/21441 SC SEC 7/20/11 7.4 7/6/11 97 3/8/11 3/8/11 Neg 160 70 6/22/11 N 250.00/21442 MC 6/30/11 8.4 6/23/11 47 6/23/11 N N 151 81 5/12/10 N 250.02/21443 MC 6/17/11 6.1 6/10/11 63 6/10/11 N N 126 77 5/11/11 N 250.00/214 Copyright 2012Ohio State Medical Association 30
    • Example of Quality Metrics for Diabetic Care inPrimary Care Practices B D E F G H I J K L M N O Eye Exam1 Insurer DOS HbA1c Date LDL Date Urine date Result BP Sys BP Dias Foot Exam CPT/ICD Date44 MC 5/12/11 6 4/5/11 56 4/5/11 N N 122 66 N N 250.00/21445 MC 4/28/11 6.4 4/25/11 77 4/25/11 N N 134 71 10/10/11 N 250.00/21446 MC 6/16/11 7.3 3/9/11 59 6/8/11 12/9/10 POS 122 64 4/7/11 N 250.00/214 SPI Dr. Total # of Patients Studied 903 45 Average HbA1C 7.1 7.0 Average LDL 91 73 Percentage of Urine Samples collected 43% 29% Average BP Systolic 133 133 Average BP Diastolic 75 70 Percentage of Eye Exams Performed 35% 67% Percentage of Foot Exams Performed 21% 18% Copyright 2012Ohio State Medical Association 31
    • COMPENSATION GUIDELINESA. Base Compensation – Uses 85% of MGMA Median by Specialty to determine base. – Will be reset each year (WRVU target) based on prior year WRVU production and market adjustments. – Adjusted upward if WRVU exceeds base target. Based on tiered compensation formula. – Adjusted downward if WRVU is below base target. – Maximum amount of base compensation to be paid through bi-weekly payroll = 80% of MGMA national 90% compensation. Copyright 2012Ohio State Medical Association 32
    • COMPENSATION GUIDELINESB. Excess WRVU Above Base Compensation Targets – Tiered structure adds a portion of excess WRVU to base compensation (not extra bonus) and a portion to incentive pool Base & Performance Bonus WRVU Tier descriptions Tier 1 = Nat Med to Avg Nat Med / Nat 75th The level of Physician production utilized in the Tiers = Tier 2 = Avg Nat Med / Nat 75th to national 75th higher of 2 yr avg production or the prior yr production Tier 3 = all WRVUs over the Nat 75th 1.0 FTE New Base = 85% Nat Median + Tier 1 + Tier 2 + Tier 3 % to payroll 85% of Nat Median + For that Physicians specialty Tier 1 - Base @ 50% of SPI rate + Tier 2 - Base 45% of SPI rate + This component added to Base and paid through bi- Tier 3 - Base 40% of SPI rate + weekly payroll Total New Base 1.0 FTE Performance Bonus Funding = Tier 1 + Tier 2 + Tier 3 + SPI % Perf Bonus Fund Tier 1 -Bonus 50% of SPI rate + This component held until contract year end and Tier 2 - Bonus 55% of SPI rate + amount to be awarded determined thorough annual Tier 3 - Bonus 60% of SPI rate + performance review - pre-defined performance SPI added Perf $ (% PCP or % other) + metrics. Total Performance Bonus Funding Copyright 2012Ohio State Medical Association 33
    • COMPENSATION GUIDELINESC. WRVU Production Below WRVU Target – At a certain level may not be eligible for a bonusD. Incentive Plan Pool – Using tiered approach amount not added to base is placed in incentive pool. – Physician has ability to add back a comparable amount using different incentives. – 15% Primary Care addition for recognition of primary care. – 5% Specialist addition to pool Copyright 2012Ohio State Medical Association 34
    • COMPENSATION GUIDELINES• There will always need to be market considerations.• Outliers will have to be looked at on an individual basis. Copyright 2012Ohio State Medical Association 35
    • Questions and Discussion Copyright 2012Ohio State Medical Association 36