Physician and Provider Engagement and Alignment

Hospital Best Practices and Recommended Strategies

• Physician Engagement
• Physician Alignment
• Physician Incentives
• Trainings and Examples

Physician Engagement

• Use the Rural Provider Leadership Summit Report to identify strategies for engaging physicians and other rural providers in discussions on transitioning to value-based systems
• Utilize Rural Health Value tools and resources to build relations with providers and engage physicians
• Build awareness with medical staff and board members that Centers for Medicare & Medicaid Services (CMS) is transforming:
  • The health care delivery system through Better Care, Smarter Spending, and Healthier People
  • Physician payment through Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)
• Explain to medical staff and board members that under the MACRA Quality Payment Program, physicians must select one of two paths to value
  • Merit-Based Incentive Payment System (MIPS), which determines payment based on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology
  • Alternative Payment Models (APMs) such as Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models (refer to CMMI for Innovation Models)
• Build awareness with medical staff and board members that Physician Compare is an online resource that allows patients and their families to find physicians and other health care professionals, provides information to assist patients with decision-making about their health care, as well as tie incentives to performance.
• Educate medical staff and board members by encouraging them to watch the following short CMS videos about MACRA, MIPS, APMs, and Physician Compare
  • Medicare Access and CHIP Reauthorization Act (MACRA) Preview- Module 1
  • 2016 Incentive Payments and 2018 Payment Adjustments- Module 2
  • Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016(and prepare for 2018)
  • Download informational materials and tools on the topic

Physician Alignment

• Align and partner with physicians and other providers to successfully transition to a value-based system and prepare for population health
• Partner with physicians to develop a common vision, goals and initiatives focused on increasing quality of care and creating value to position the hospital for participating in shared savings programs, Accountable Care Organizations (ACO) and patient centered medical homes
• Develop an integrated clinical physician and hospital leadership team
• Coordinate a local provider network to generate referrals for specialty services and other inpatient services to maximize revenue in a fee-for-service payment environment, at least during the transition period
• Build relationships with other regional hospitals and physicians to position the hospital for developing and implementing affiliation strategies
• Align with physicians through:
  • Functional alignment, such as shared medical records and billing
  • Governance alignment, such as a shared management team
  • Contractual alignment, to include both employed and non-employed physicians

Physician Incentives

• Develop physician contracts based on Relative Value Units (RVU) and include productivity bonuses and incentives for, quality, patient outcomes and experience, reduced cost, growth, panel size and timely chart completion. Refer to the sample physician agreement.
• Consider the following recommendations for developing and managing physicians contract based on RVU:
  • Set the base compensation at an attainable level such as 50th percentile of Medical Group Management Association (MGMA) benchmarks. However, consider 25th to 35th percentile for new providers
  • Establish a minimum threshold for pre-determined dollar amount per RVU (or Work RVU) once the threshold has been met
  • Develop the RVU based incentives to directly correlate between provider effort and incentive dollars
  • Provide physicians monthly updates on performance measures relative to goals
• Establish a practice manager role to provide oversight of operations and ensure proper goal alignment between physician practice and hospital
• Establish policies related to chart completion incorporated into the providers’ employment contract and disciplinary action is taken if providers do not adhere to the policy.