Part A Support
including Performance-based Incentives
October 21-24, 2014
Robert H. Tessier
Senior Reimbursement Consultant
HBP Services
11 Research Drive , Suite 2
Woodbridge, CT 06525
203 397-8000
rtessier@hbpworld.com
www.hbpworld.com
Performance Based Incentives
Implement performance based incentives to include in your
Part A contract.
Performance Based Part A –
WHAT IT IS NOT/WHAT IT IS
Page 3
How To Proceed?
Page 7
Performance Based Checklist
Page 9
Part A Fact Book
Page 15
Performance Based Part A- What IT IS NOT
The foundation for Part A support will continue to be the hours documented, paid at a
“reasonable” hourly rate. HBP always uses the Medicare Reasonable compensation
Equivalent (RCE) adjusted by 3% inflation +$5,000 CME and actual cost of Malpractice.
IT IS NOT:
–
a replacement for the need to document Part A services and prepare
Time Studies.
–
a solution for those Pathologists who don’t want to be judged on
results.
–
a concept to be used for those who ASSUME the Hospital knows your
value.
3
Performance Based Part A- What IT IS NOT
IT IS NOT:
–
intended for those who do not take the time to provide a effective
education to administration.
–
a series of simple calculations that eliminate the need for dialogue
with the Hospital.
–
a good approach if the goals of the Hospital are not aligned with those
of the Pathologists.
–
the right methodology when the Pathologists only perform required
Part A functions.
–
a static formula that can be applied over a multi-year contract.
4
Performance Based Part A - What IT IS
IT IS:
–
A new approach for those Pathologists with a great story to tell.
–
An opportunity to formally discuss results with Administration.
–
A reward for those who can demonstrate accomplishments.
–
Developing consistent goals and objectives for the Hospital and the
Pathologists.
5
Performance Based Part A - What IT IS
IT IS:
–
Formulas that reward specific benchmarks.
–
A methodology that evolves as circumstances change.
–
A system that assures an effective balance so that both the Hospital
and the Pathologists will mutually benefit from improved results.
6
How To Proceed?
Performance Incentives might be a new concept for both parties
•
Present a variety of options in line with Hospital priorities.
•
Select incentives that present an opportunity for an ongoing dialogue.
•
Review the items being measured and modify goals each year.
•
Assign a value to each component that is either a fixed amount or a % of
savings/improvements.
•
Define the baseline and criteria for change.
7
How To Proceed?
•
Present items that can be easily quantified and determine the source to be used:
Finance Reports, Department LIS, Practice Billing Data for date of service
•
Include items that need to be accomplished as part of the Short/Long Term Goals
of the Lab.
•
Establish a Department Development Fund as the beneficiary of some incentives
“25% of savings to Practice and 25% to the Department Fund”
(the other 50% retained by the hospital)
•
If the incentive is more difficult to achieve in a subsequent year, the payment
should be increased. (assume the bar will continue to be raised)
8
Performance Based Checklist
Management
Design/Implement Outpatient Programs
(i.e. Blood Drawing Station)
Supervise Quality Assurance;
Accreditation Standards
Reconcile (TC=PC) & Maximize Revenue
Capture
Achieve Economy of Scale
Develop Regional Initiatives with other
Hospitals, Pathology Groups and
Commercial Labs
9
Performance Based Checklist
Turn Around Time
Surgical Pathology – General/Simple
Major Surgical Path – Resections/Complex
Autopsy
Frozen Sections
Troponin Results (ED)
CAP Standards
Proficiency Testing Results in Clinical Lab
Minimum (less than 5) Phase I Deficiencies
in CAP Inspections
Lab Test Utilization
Reduce Unnecessary Testing
Satisfaction Survey/
Improve Patient Satisfaction
Achieve Medical/Nursing Staff Satisfaction
Design/Implement Surveys
Press Ganey
10
Performance Based Checklist
Marketing/Sales
Create a Marketing Plan for AP & CP
Integrate the Department and Practice
Website
Prepare Customized Marketing/Sales
Collateral
Contribute to the Sales Commission
Incentive Payment for AP
Participate in Client Calls with Sales Reps
Explore and Present Opportunities for
New Business
Educate and Provide Feedback to the
Client Service/Sales Staff
11
Performance Based Checklist
Special Arrangements
Send-Out Testing
Propose Creative Arrangements with
GI/GU/Derm Groups
Reduce Send-Out Testing
Develop a Detailed Plan
Negotiate Better Arrangements for Cost
and TAT
Blood Utilization
Implement Blood Management Program
12
Performance Based Checklist
Molecular Pathology/
New Technology
Compliance
Develop an Evolving Test Menu
Educate Medical Staff
Participate in National Conferences
Develop/Implement Laboratory
Compliance Plan
Assure Accurate Coding
Train and Monitor Commitments made by
Sale Reps
13
Performance Based Checklist
Management
Expand Role in Laboratory Operations
Propose Goals and Objectives
CAP Certificate for Medical Directorship
Utilize Voice and Template Reporting
Participate in Negotiation with Vendors
Improve Relationship with Hospital and
Lab Personnel
Coordinate EMR Connectivity with
Referring Physicians
Mentor New Laboratory Managers
14
Part A Fact Book
1.
Part A & RCE Calculation
(Medicare Reasonable
Compensation Equivalent ) 2004
•
•
•
•
History of Part A Payments
Time Study Summary
Average Part A Hours
RCE Calculation
– $219.5 (2004) @ 3% Inflation
= $295 (2014)
+ CME $5,000
+ Malpractice $15,000 (Actual)
= $315k / 2,080 hrs. =
$151.60
•
•
Medicare Published RCE Documents
Part A Calculation
Metro < 1m = $219.5k
Metro >1m = $215.7k
Non-Metro = $208k
This is the “average” compensation
15
Part A Fact Book
2. Time Study Documentation
•
•
•
•
Detailed Time Study Worksheet
Minimum 4 weeks per year
Maximum 2 weeks per quarter
Customize the format
3. Department Responsibilities
•
•
•
Matrix of Responsibilities (Pages 11-12)
Department Organizational Chart
Goals & Objectives
4. Committees
•
•
List of Committees by Pathologist
List of PA Committees (if paid by Practice)
16
Matrix of Responsibilities - Department
Chief
Pathologist Pathologist
A
B
Medical Director
Surgical Pathology
Cytology
Autopsy
Chemistry
Microbiology
Hematology
Blood Bank/Transfusion
Coag Hemostasis
Collections & Processing
Point of Care Testing
Molecular Services
Department LIS
Information Systems
EMR Connectivity
Informatics
17
Pathologist
C
Pathologist
D
Matrix of Responsibilities - Department
Chief
Pathologist Pathologist
A
B
Medical Staff
Administration Interface
Human
Resources/Incentives
Equipment
Technology
Compliance
Technical Plan
Revenue/Controls
Finance Interface
Budgeting
Marketing/Public
Relations
Sales Staff
Web Site
Goals & Objectives
Department Fund
18
Pathologist
C
Pathologist
D
Part A Fact Book
5. Part A Services
•
Description of Part A Services
(customized for your Hospital)
6. Current Contract
•
Agreement for Pathology Services
Contract
7. Annual Dept. Report
•
Annual Laboratory Quality /
Department Report
Press Ganey Scores
•
8. Comparative Data
•
•
•
•
Average Weekly Part A Hours - Chief
Average Weekly Part A Hours – Associates
Current Part A as a Percentage of
Calculated Part A
Medicare Cost Report Schedule A-8-2
FOI Request
19