Managed Care Contract Negotiations
Dec 22

How to evaluate pay-for-performance initiatives

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:

  1. Does the provider give you advance notice of the quality measures it uses?
  2. 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?
  3. Do you know in advance what the benchmarks will be?
  4. Will you have the ability to determine as you go how your performance measures up?
  5. Are the performance determinations subjective?
  6. Is the formula for translating your performance score into an incentive payment transparent?
  7. Will complying with the reporting requirements be administratively burdensome?
  8. Who has access to the quality data once they are amassed by the payer?
  9. Are your measures averages for the nation or the region?
  10. If the arrangement does not work for you, how can you release yourself from the P4P program?
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →