May, 2015:

Patient Access and Physician Compensation: Why Marrying These Two Concepts is Critical to Success

From the Consultant’s Corner 5/19/15-HIStalk Practice

May 19, 2015 News
Patient Access and Physician Compensation: Why Marrying These Two Concepts is Critical to Success

At first glance, there might seem to be little correlation between patient access and physician compensation. Access models have always affected a patient’s ability to receive appropriate healthcare in a timely manner, yet providers seldom have any vested interest in actually fostering access to their services.

Healthcare organizations can overcome that challenge by aligning access goals with physician compensation. In turn, they stand to realize greater patient satisfaction and loyalty, improved care quality, and overall increased provider and staff productivity and utilization.

Access Matters
Access to care is a primary requisite for managing a patient’s overall health throughout the care continuum. After all, patients who cannot get timely access to the appropriate care are likely to look for it elsewhere — thus preventing a health facility from being able to effectively manage the patient’s outcomes and care costs.

Unfortunately, barriers exist in many healthcare organizations that prevent unfettered patient access. For example, primary care providers who migrate from private practice to hospital employment frequently have difficulty referring patients to specialists — particularly newly employed ones — within the system. This issue is especially problematic in organizations such as academic medical centers, where specialists must balance time between patient care, teaching, and research. Specialist scheduling templates often fail to accommodate an appropriate mix of patient volume by visit type and payer.

Unfortunately, we have identified far too many schedule templates that were not set up to treat enough patients to cover base salary productivity expectations. The health system therefore loses money on both the employed primary care providers and the specialists — not to mention the negative impact on patient satisfaction.

Patients caught in situations such as these may either leave or be referred outside the health system. The factors behind leakage not only frustrate patients, but also thwart the health system’s goals to acquire and retain new patients. Likewise, leakage hampers a healthcare organization’s ability to manage patient care in terms of quality and cost containment.

To address this problem, organizations must consider patient access as part of provider compensation. For instance, employed physician compensation plans should include baseline targets for new patient visits, as well as overall physician productivity expectations. Moreover, clinical integration models including full employment or clinical alignment programs should contain a financial model for monitoring the downstream revenue captured by the hospital or specialty areas.

Steps Toward Better Compensation Alignment
Adjusting an organization’s compensation strategy to re-enforce patient access goals requires a concerted approach. Here are a few strategies for practices and hospitals to keep in mind:

· Review the current plan. Look first at physician compensation from a historical perspective. Then, determine to what degree the current plan reflects productivity and performance objectives. As part of this process, review industry and regional benchmarks by practice specialty as a guide to reasonable productivity and compensation levels. Planning carefully and making small changes over time can help ensure the effective alignment of compensation with long-term goals.

· Examine scheduling. Make sure schedules are set up to support patient volume by specialty and visit type. For example, the number of patients a cardio-thoracic surgeon is expected to see should be very different from that of a primary care physician. As a result, it is necessary to consolidate and standardize visit types and duration within various specialties. For example, one practitioner should not be allowed to spend an average of an hour with each patient if other practitioners in the same specialty spend an average of 15 minutes.

In addition, to achieve organizational growth objectives, compensation plans should encourage providers to see some combination of new and existing patients. New patients represent incremental revenue not just to the practice, but to the entire health system. Remember that in order to access downstream revenue from employed physician models, new patients must be able to see the employed primary care physicians and specialists, plus have access to the full range of health system services.

· Regularly review the plan. An organization should establish a periodic review process to ensure that the plan is working and that it incentivizes the intended behaviors—all while mitigating any unintended consequences. Equally important is a degree of on-going physician dialog and engagement around the plan. Organizations should provide a forum that allows providers to ask questions and voice concerns. This type of communication platform allows leadership to resolve issues before they become larger problems.

Achieving synergy between patient access and physician compensation should be an ongoing exercise. Although it may seem like a daunting task, healthcare organizations do not have to go it alone. By consulting with peers and outside experts, practices, hospitals and health systems can design compensation plans that successfully align with their overall patient access and performance goals.


Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Focusing resources: 3 questions to ask when prioritizing large-scale initiatives



Improving Population Health using Epic’s Healthy Planet

Population Health Management isn’t a concept that is new to the healthcare industry however, efficiently managing high-cost and high-risk patients is becoming a necessity with payment models focusing on reducing cost and improving outcomes. With this, many organizations are instituting an increased focus towards population health management, participating as Accountable Care Organizations (ACOs) in order to more effectively identify, understand, engage, and track patient populations. An ACO delivering high-quality and low cost care will share in the savings that is achieved for the Medicare program.

Many EHR vendors, including Epic, are looking to provide tools to assist organizations in moving toward better and more coordinated care for individuals, greater health and disease prevention, and less healthcare expenditure.  Healthy Planet is Epic’s solution for helping organizations achieve these goals.  It allows clinicians to identify and address gaps in care with patient populations using tools within Epic – EpicCare Ambulatory, MyChart and Cogito – to take action on population health analytics, integrate care management and coordination, and engage the patient in their care.

Many of our clients are part of an Accountable Care Organization (ACO) establishing integrated care teams made up of physicians, nurses and social workers that utilize the tools provided by Healthy Planet such as navigators, dashboards and bulk ordering and communication functions as well as MyChart to help manage the needs of their high-risk patients. Healthy Planet’s ACO functionality has been used to define ACO patient populations, complete patient questionnaires for risk stratification, track patient outreach, provide care management which includes documentation of medication compliance, care plans and goals, as well as interaction through MyChart. Organizations have also begun to create team Longitudinal Plans of Care allowing other clinicians throughout their organization as well as other Epic organizations to see their care efforts in one concise place.

As a result, organizations have already begun to see the benefits of their Population Health Management efforts meeting the goals of:

  • Accurately and efficiently capture data for preventive care and disease management services
  • Monitor the performance of providers on closing care gaps for these services
  • Implement chronic care management workflows for care managers
  • Apply risk stratification models to your patient populations
  • Increase efficiency through bulk ordering and communication
  • Engage patients through MyChart
  • Improve transitions of care and patient engagement with a longitudinal plan of care


Through their care management teams, they have been able to better understand patient needs in areas ranging from transportation to doctor’s appointments and picking up medications to education regarding their clinical care. Reporting shows decreases in Emergency Room visits as a specific example and clients continue to gather data that demonstrates how critical care management is to overall population health.   The successful implementation of tools such as Healthy Planet provide both short term and long term benefits that result in a more educated ACO and an overall improvement in the healthcare experience and general well-being of individual patients.

Avoiding Program Year (PY) 2015 CMS Negative Payments Applied in 2017

It’s not too late to avoid the CMS Stage 2 Meaningful Use negative payments for Program Year (PY) 2015 that will be imposed with payments issued starting in January, 1st, 2017.

On January 29, 2015, CMS announced its intention to issue a new rule in early spring 2015, which would change the Meaningful Use (MU) reporting period for Stage 2 from a full calendar year to a 90 day calendar quarter in 2015. This change is great news for Eligible Professionals (EP) that have not yet been able to implement all the requirements to meet MU Stage 2 guidelines. An important point to note is that CMS negative payments are imposed two (2) years after the calendar year (CY) in which the services took place. In early January 2015, thousands of EPs were surprised with the first negative payments for non-participation issued by CMS for services provided during Program Year (PY) 2013.

Providers have a great opportunity to implement the requirements needed to meet MU Stage 2 criteria for 2015 and collect the eEHR data needed to meet the new 90 day reporting period during the last quarter of 2015, and most importantly; avoid the penalties. But they must be proactive and act now. There are a number of new requirements for MU Stage 2 that require implementation and planning in order to meet MU Core and Menu measures.

Some of the new requirements are but not limited to:

  • Correct certified version of EHR software technology installed to track Stage 2.
  • Upgraded workflows and settings for the Patient Portal fully operational to meet higher communication thresholds for Stage 2.
  • Develop workflows and Implement the ability to incorporate lab results into patient charts.
  • Must have the ability to import imaging results and associated reports into the patient’s EHR record.
  • Must have the ability to transmit using QRDA III, to CMS by 12/31/15.


In touching on the consequences of non-compliance, the penalties for failing to attest are considerable. Most importantly, penalties for each program and subsequent years are cumulative and could add up to a negative 17% in some cases.

Below is a summary of current CMS Medicare Program penalties for non-participation.

MU incremental negative payments up to 5% in subsequent years

PY 2015 reduced starting with attestation in CY 2016, imposed in CY2017 – 3%

PQRS – All Groups and EPs – Negative Payment Adjustments

-2.0% Applied starting January 1st, 2017 for services during CY 2015

-2.0% Applied to each subsequent year

Value Based Payment Program – Groups 10 – 99 EPs submitting claims under a single Tax ID

-2.0 Applied starting January 1st, 2017 for services during CY 2015

Value Based Payment Program – Groups >100 EPs submitting claims under a single Tax ID

-4.0 Applied starting January 1st, 2017 for services during CY 2015

Value Based Payment Program – Solo Practitioners, first year this category will get negative payments

-2.0 Applied starting January 1st, 2017 for services during CY 2015


Note: All negative adjustments are cumulative by program and year.


For example, a solo practitioner failing to attest to all 3 programs during PY 2015, can expect to start receiving a negative 7% penalty applied to Part B reimbursements starting in 2017, and negative 9% for groups of >100 working under a single tax ID. This negative payment is in addition to any penalties for non-participation in prior or subsequent years and are not eliminated for compliance and subsequent years.


There is no question that these penalties can adversely impact the cash flow of any provider, especially those with a high Medicare patient mix. There is a very small window of less than 5 months to prepare, implement, test and successfully generate valid MU data for the last full quarter of 2015, however, time is of the essence, and for EPs that lack the in-house resources to comply with minimum requirements for MU Stage 2, this is the time to implement a plan and seek assistance to avoid CMS negative payments for Program year 2015.

Modernizing Physician Compensation Plans: Webinar May 29th 12:30-1:30 EST

Modernizing Physician Compensation Plans

Do your physician compensation plans include incentives for improving access to new patients? Are your compensation plans based upon productivity to ensure that access to all patients from all participating insurance plans is readily available?

Culbert Healthcare Solutions invites you to join Randy Shulkin, MBA, FACMPE, Senior Consultant, for a free webinar on Friday, May 29th at 12:30 PM Eastern as he discusses how to develop a physician compensation strategy that is aligned with the goals and objectives of your organization.  As the industry continues to look for ways to provide affordable care to all patients, a responsive, flexible approach to managing physician compensation and incentives is needed to keep the focus on prompt, quality care.

This one hour webinar will discuss and demonstrate the following: