part a support including performance-based incentives

Part A Supportincluding Performance-based Incentives

HBP Services11 Research Drive , Suite 2

Woodbridge, CT 06525203 397-8000

[email protected]

October 21-24, 2014

Robert H. TessierSenior Reimbursement Consultant

West, Midwest & Canada Regional APC/PDAS Meeting

Performance Based Incentives

Implement performance based incentives to include in your Part A contract.

Performance Based Part A – WHAT IT IS NOT/WHAT IT IS

How To Proceed?

Performance Based Checklist

Part A Fact Book

Page 3

Page 7

Page 9

Page 15

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Performance Based Part A- What IT IS NOT

The foundation for Part A support will continue to be the hours documented, paid at a “reasonable” hourly rate. HBP always uses the Medicare Reasonable compensation Equivalent (RCE) adjusted by 3% inflation +$5,000 CME and actual cost of Malpractice.

IT IS NOT:

– a replacement for the need to document Part A services and prepare Time Studies.

– a solution for those Pathologists who don’t want to be judged on results.

– a concept to be used for those who ASSUME the Hospital knows your value.

Performance Based Part A- What IT IS NOT

IT IS NOT:

– intended for those who do not take the time to provide a effective education to administration.

– a series of simple calculations that eliminate the need for dialogue with the Hospital.

– a good approach if the goals of the Hospital are not aligned with those of the Pathologists.

– the right methodology when the Pathologists only perform required Part A functions.

– a static formula that can be applied over a multi-year contract.

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Performance Based Part A - What IT IS

IT IS:

– A new approach for those Pathologists with a great story to tell.

– An opportunity to formally discuss results with Administration.

– A reward for those who can demonstrate accomplishments.

– Developing consistent goals and objectives for the Hospital and the Pathologists.

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Performance Based Part A - What IT IS

IT IS:

– Formulas that reward specific benchmarks.

– A methodology that evolves as circumstances change.

– A system that assures an effective balance so that both the Hospital and the Pathologists will mutually benefit from improved results.

How To Proceed?

Performance Incentives might be a new concept for both parties

• Present a variety of options in line with Hospital priorities.

• Select incentives that present an opportunity for an ongoing dialogue.

• Review the items being measured and modify goals each year.

• Assign a value to each component that is either a fixed amount or a % of savings/improvements.

• Define the baseline and criteria for change.

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How To Proceed?

• Present items that can be easily quantified and determine the source to be used:Finance Reports, Department LIS, Practice Billing Data for date of

service

• Include items that need to be accomplished as part of the Short/Long Term Goals of the Lab.

• Establish a Department Development Fund as the beneficiary of some incentives“25% of savings to Practice and 25% to the Department Fund” (the other 50% retained by the hospital)

• If the incentive is more difficult to achieve in a subsequent year, the payment should be increased. (assume the bar will continue to be raised)

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ManagementDesign/Implement Outpatient Programs (i.e. Blood Drawing Station)

Supervise Quality Assurance; Accreditation Standards

Reconcile (TC=PC) & Maximize Revenue Capture

Achieve Economy of Scale

Develop Regional Initiatives with other Hospitals, Pathology Groups and Commercial Labs

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Turn Around Time Surgical Pathology – General/Simple

Major Surgical Path – Resections/ComplexAutopsyFrozen SectionsTroponin Results (ED)

CAP Standards Proficiency Testing Results in Clinical Lab

Lab Test Utilization Reduce Unnecessary Testing

Satisfaction Survey/ Improve Patient SatisfactionPress Ganey Achieve Medical/Nursing Staff Satisfaction

Design/Implement Surveys

Minimum (less than 5) Phase I Deficiencies in CAP Inspections

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Marketing/Sales Create a Marketing Plan for AP & CPIntegrate the Department and Practice WebsitePrepare Customized Marketing/Sales CollateralContribute to the Sales Commission Incentive Payment for AP

Participate in Client Calls with Sales RepsExplore and Present Opportunities for New BusinessEducate and Provide Feedback to the Client Service/Sales Staff

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Special Arrangements

Propose Creative Arrangements with GI/GU/Derm Groups

Send-Out Testing Reduce Send-Out TestingDevelop a Detailed Plan

Negotiate Better Arrangements for Cost and TAT

Blood Utilization Implement Blood Management Program

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Molecular Pathology/ Develop an Evolving Test Menu New Technology Educate Medical Staff

Participate in National Conferences

Compliance

Develop/Implement Laboratory Compliance PlanAssure Accurate CodingTrain and Monitor Commitments made by Sale Reps

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Management Expand Role in Laboratory Operations

Propose Goals and Objectives

CAP Certificate for Medical Directorship

Utilize Voice and Template Reporting

Participate in Negotiation with Vendors

Coordinate EMR Connectivity with Referring Physicians

Mentor New Laboratory Managers

Improve Relationship with Hospital and Lab Personnel

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Part A Fact Book

1. Part A & RCE Calculation

(Medicare Reasonable

Compensation Equivalent )

2004

Metro < 1m = $219.5k

Metro >1m = $215.7k

Non-Metro = $208k

This is the “average” compensation

• History of Part A Payments• Time Study Summary• Average Part A Hours• RCE Calculation

– $219.5 (2004) @ 3% Inflation = $295 (2014)

+ CME $5,000 + Malpractice $15,000 (Actual)= $315k / 2,080 hrs. = $151.60

• Medicare Published RCE Documents• Part A Calculation

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Part A Fact Book

2. Time Study Documentation

3. Department Responsibilities

4. Committees

• Detailed Time Study Worksheet• Minimum 4 weeks per year• Maximum 2 weeks per quarter• Customize the format

• Matrix of Responsibilities (Pages 11-12)• Department Organizational Chart• Goals & Objectives

• List of Committees by Pathologist• List of PA Committees (if paid by Practice)

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Matrix of Responsibilities - Department

ChiefPathologist

APathologist

BPathologist

CPathologist

D

Medical DirectorSurgical PathologyCytologyAutopsyChemistryMicrobiologyHematologyBlood Bank/TransfusionCoag HemostasisCollections & ProcessingPoint of Care TestingMolecular ServicesDepartment LIS Information SystemsEMR ConnectivityInformatics

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Matrix of Responsibilities - Department

Chief Pathologist A

Pathologist B

Pathologist C

Pathologist D

Medical StaffAdministration InterfaceHuman Resources/IncentivesEquipmentTechnologyCompliance PlanTechnical Revenue/ControlsFinance InterfaceBudgetingMarketing/Public RelationsSales StaffWeb SiteGoals & ObjectivesDepartment Fund

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Part A Fact Book

5. Part A Services

6. Current Contract

7. Annual Dept. Report

8. Comparative Data

• Description of Part A Services (customized for your Hospital)

• Agreement for Pathology Services Contract

• Annual Laboratory Quality / Department Report

• Press Ganey Scores

• Average Weekly Part A Hours - Chief• Average Weekly Part A Hours – Associates• Current Part A as a Percentage of

Calculated Part A• Medicare Cost Report Schedule A-8-2

FOI Request