SPC decided on HbA1c as a process measure for its P4P program and is now conside

ID: 2774626 • Letter: S

Question

SPC decided on HbA1c as a process measure for its P4P program and is now considering three methods of allocating rewards. For each of the measures below, a physician receives a $5,000 bonus if: - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state average of 80 percent (relative performance). - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state goal of 90 percent (benchmark performance). - the difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year compared to the previous year is greater than 10 percent (improvement performance). The percent of diabetic patients that had at least two HbA1c tests in the past year for each SPC physician is shown below: Physician Jan-Jun Jul-Dec A 60% 76% B 70% 81% C 80% 81% D 90% 91% a) For the Jul-Dec period, what would be each physician's P4P if rewards were allocated based on relative, benchmark, and improvement performance? b) Which method(s) of allocating rewards would you recommend? ANSWER SPC decided on HbA1c as a process measure for its P4P program and is now considering three methods of allocating rewards. For each of the measures below, a physician receives a $5,000 bonus if: - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state average of 80 percent (relative performance). - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state goal of 90 percent (benchmark performance). - the difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year compared to the previous year is greater than 10 percent (improvement performance). The percent of diabetic patients that had at least two HbA1c tests in the past year for each SPC physician is shown below: Physician Jan-Jun Jul-Dec A 60% 76% B 70% 81% C 80% 81% D 90% 91% a) For the Jul-Dec period, what would be each physician's P4P if rewards were allocated based on relative, benchmark, and improvement performance? b) Which method(s) of allocating rewards would you recommend? ANSWER

Explanation / Answer

relative performance (the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state average of 80 percent):

Physician A= $0 Bonus (since less than 80% State average)

Physician B= $5000 Bonus (since more than 80% State average)

Physician C= $5000 Bonus (since more than 80% State average)

Physician D= $5000 Bonus (since more than 80% State average)

benchmark performance (the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state goal of 90 percent):

Physician A= $0 Bonus (since less than 90% state goal)

Physician B= $0 Bonus (since less than 90% state goal)

Physician C= $0 Bonus (since less than 90% state goal)

Physician D= $5000 Bonus (since more than 90% state goal)

improvement performance (the difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year compared to previous year is greater than 10 percent):

Physician A= $5000 bonus (76%-60%=16%) since greater than 10 percent

Physician B= $5000 bonus (81%-70%=11%) since greater than 10 percent

Physician C= $0 bonus (81%-80%=1%) since less than 10 percent

Physician D= $0 bonus (91%-90%=1%) since less than 10 percent

b) According to me of the above three methods, i would recommend to follow improvement performance as well as benchmark performance method. Since improvement performance method will motivate the physician to improve their performances from the previous period and a 10% improvement in performance is something which must be rewarded. Also it is essential to follow benchmark performance method since after a point in time performance cannot exceed much and there should be stability in performance which can be achieved by rewarding through benchmarking method, since a physician whose more than 90% patient had at least 2 tests must be rewarded also since after achieving 90% result performance cannot exceed more than 10%.

Therefore, according to me both improvement performance and benchmark performance should be used for rewarding physician.

a) 1. For the Jul-Dec period,calculating each physician's P4P if rewards were allocated based on