Employers and insurers including Medicare have initiated a number of "pay for performance" (P4P) programs across the country. P4P programs are intended to improve quality by financially rewarding doctors who achieve pre-defined measures such as improved clinical outcomes, evidence-based medical procedures, generic prescribing rates, information technology, and high levels of patient satisfaction.
The Bronx Community Health and Acute Medical Performance Improvement Organizational Network (CHAMPION) Program, Montefiore Medical Center’s two-year P4P program demonstration project, is funded by a $2.4 million grant from the New York State Department of Health. The program targets heart patients and those with heart disease risk factors like diabetes and hypertension.
The CHAMPION program encompasses care delivered in inpatient and outpatient settings. The inpatient component includes the acute care division, emergency department, inpatient units, intensive care units, operating rooms, and catheterization laboratory, and incentivizes corresponding clinical departments and acute care services. The outpatient component involves Montefiore Medical Group providers and eligible voluntary primary care providers for adult patients.
Through this program, Montefiore outpatient physicians receive incentive payments for meeting predefined measures of outpatient and inpatient care, including controlling high blood pressure, checking weight, providing nutrition counseling, checking smoking status, giving flu vaccines, patient satisfaction surveys, and utilization rates. In the inpatient hospital settings, physician performance measurements also include the number of readmissions for heart care patients within a year’s time and patient satisfaction survey scores. The final Bronx CHAMPION Program measures were selected from a standardized list provided by the New York State Department of Health with MMC physician input. A higher score on the list of electronically recorded performance standards would yield a larger incentive payment. Payments are within national guidelines for P4P incentives.
Unlike P4P programs conducted by individual insurers, the Bronx CHAMPION Program is applicable to patients of all payer types. Montefiore partnered with the state and insurers to create a pool of monies for one set of incentive-pay criteria.
The program relied primarily on chart review to obtain clinical performance data but information was also derived from Montefiore's highly sophisticated clinical information system and from patient surveys.