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 the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.