When looking at the growing pool of pay-for-performance (P4P) programs, you might wonder how to determine what you're getting into before you sign up. To understand your organization's rights and obligations under such a program, consider the following questions when evaluating P4P proposals:
- Does the provider give you advance notice of the quality measures it uses?
- Many payers establish programs that rate and grade performance based on the performance of a community of providers. Some programs refer to these as "silos" or "pods." Do you agree with the group of providers with whom you are included?
- Do you know in advance what the benchmarks will be?
- Will you have the ability to determine as you go how your performance measures up?
- Are the performance determinations subjective?
- Is the formula for translating your performance score into an incentive payment transparent?
- Will complying with the reporting requirements be administratively burdensome?
- Who has access to the quality data once they are amassed by the payer?
- Are your measures averages for the nation or the region?
- If the arrangement does not work for you, how can you release yourself from the P4P program?
