PracticeLink Magazine

FALL 2014

The career development quarterly for physicians of all specialties, PracticeLink Magazine provides readers with feature articles, compensation stats, helpful job search tips—as well as recruitment ads from organizations across the U.S.

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50 | PracticeLink.com FALL 2014 Healthcare Association in Oakland, Calif. IHA is a California nonproft leadership group that brings together multiple stakeholders in a pay-for-perfor- mance program. Across the country, payers and physician groups have negotiated how to handle risk under systems that reward providers for volume and low use of services even though the physicians might care for a group of patients with proportionately high chronic disease status or comorbidities. At the same time, patient copayments under most managed care plans were based largely on cost of services. The fnancial incentives for physicians and patients did not match their quality or value. Reforming the system Controls on utilization and shared risk have yet to produce the sort of quality outcomes and cost savings promised. Providers, payers, employers and policymakers have been seeking a solution that improves patient satisfaction and outcomes while also reducing the cost of health care. This has given rise to private and public emphasis on accountable care alignment of compensation. 1. How will I be working with others in the organization? 2. How will I be communicated with about important matters? 3. Do you measure patient satisfaction? How? 4. What types of bonuses, if any, do you pay based on patient satisfaction? 5. Do you have other quality metrics and incentives in place for physicians? 6. Have you implemented electronic health records? 7. How do you use technology in your practice for tracking and reporting data? 8. What kind of voice will I have in patient complaints? 9. Do you have medical homes or team-based care? 10. How accessible are your preventive care services to patients? n —Teresa Odle Y OU CAN'T PREDICT HOW SUCCESSFUL AN organization will be under the transition from volume- to value-based payment methods. But if it's somewhere you want to work, you can ask a few good questions to determine your fit into the organization's culture and compensation plans, and determine their readiness for reform. It's important to determine a group's culture, says physician data and compensation consultant Todd Evenson. He says that cultural issues always have been important, but if a practice still is very production focused—and you want more time with patients—it might not be a good fit. It also might mean that the physicians aren't preparing for the transition to value-based payment. Consider the following questions when assessing fit and readiness for value-based payment and to relative value units (RVUs) for services that were based on time and intensity of work and adjusted for factors such as geographic location. This meth- odology emphasized volume of work. Among commercial payers in particular, quality and cost controls came from managed care plans, often by restraining utiliza- tion of medical services. In turn, physician groups often assumed the risk for covered patients through capitated arrangements, in which providers were paid a set fee per member per month, regardless of the members' health status at enrollment or as a result of their care. Much of the evolution in reimbursing providers based on quality and value likely occurred as "a back- lash toward utilization management practices of the 1990s," says Lindsay Erickson, manager of the value- based Pay for Performance program for the Integrated Preparing for value-based compensation Continued from page 48 How to evaluate an employer's readiness for value-based reform

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