Health policy discussion responses

Review posts submitted by your classmates.  In your responses, propose suggestions and/or alternate options to strengthen and support the response to the director.

Post #1 Savannah Ventura

As the head of physician contracting at a small community hospital, I have been asked to evaluate whether the hospital should shift its employed physicians away from an annual salary model and into a model that incentivizes quality outcomes. The physicians currently employed by the hospital are paid on salary without any quality or outcome incentives; however, area physicians with hospital privileges used by medical groups are compensated for quality outcomes instead of an annual salary. The first step in approaching the request from the director of contracting, my boss, compares results from doctors paid by salary to those paid by incentives based on quality outcomes (Teitelbaum & Wilensky, 2017). If quality outcome results are better for incentivized physicians, then the change should be recommended and started. 

For decades, healthcare costs in America have escalated without comparable improvements in quality (Ryan, Burgess, PEsko, Borden, & Dimick, 2015). Current federal and private policies have turned to a Pay-for-Performance (P4P) model to introduce more powerful incentives for improving care. Physicians get bonuses for meeting certain quality of care standards. These standards can range from demonstrating that they have done procedures that ought to be part of a thorough physical, such as taking blood pressure, to producing a positive health outcome, such as a performance target like lower cholesterol (Herzer & Pronovost, 2015). 

Potential competing stakeholder values can affect the direction in which the organization should go. Organizations that put stakeholders' interests ahead of profits generate greater workforce engagement and thus deliver the superior financial results that they have made a secondary goal. At first glance, this may seem counterintuitive until the business is looked at as an ecosystem composed of groups that cooperate to maximize value creation and compete to realize their share of that value. No system can thrive if one member group continually benefits at the expense of others. Any unfairness in treatment will result in suppliers prioritizing other customers, staff leaving to work for other companies, or customers defecting to other suppliers or shareholders selling. In this context, the strategy is the art of balancing how value is shared among different stakeholders so that overall value creation is maximized. It aims to sustain superior profitability over the long run rather than maximize it in the short term (Ryan et al., 2015).

A stepwise plan to respond to the director's request should include the following: start a compensation committee; initiate a pilot plan, optional to physicians between the old plan and the new plan; begin pilot on the primary care arena first; initiate compensation plan with existing incentive metrics; keep open communication within the organization; and push to increase enrollment in incentive-based compensation (Herzer & Pronovost, 2015). 

References

Herzer, K. R., & Pronovost, P. J. (2015). Physician motivation: Listening to what pay-for-performance programs and quality improvement collaboratives are telling us. Joint Commission Journal on Quality and Patient Safety, 41(11), 522-528. doi: https://doi.org/10.1016/S1553-7250(15)41069-4

Ryan, A. M., Burgess, J. F., Pesko, M. F., Borden, W. B., & Dimick, J. B. (2015). The early effects of medicare's mandatory hospital pay‐for‐performance program. Health Services Research, 50(1), 81-97. doi: https://doi.org/10.1111/1475-6773.12206

Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Jones & Bartlett Learning: Burlington, MA.

Post #2 Jasmine Matthews

As the head of physician contracting a small hospital in the community I would firstly evaluate the local hospitals that are in the area and how the conduct their contracts to physicians. I would gather a full and detailed analysis of how the physicians feel about an incentive quality outcome and how they feel about a salary based outcome. In addition to the local hospitals, I would also gather information from the surrounding areas and the larger scaled hospitals just to cover all my bases. Secondly, I would evaluate the quality of care our hospital where our physicians are paid by means of annual salary versus the quality of care for those on an incentive standpoint. I believe wherever the best quality of care lies there would I submit my recommendation on either changing or holding on to what we have. 

The healthcare field has been known to use incentive to improve physicians care of patients as it would in turn lower the cost of healthcare for the providers. This was apart of legislation dating back to the Health Care Act. Also in the Health Care act was reprimands if participation was not there. As of lately, stated in the Affordable Care Act there is more of an alignment between providers, payers and healthcare workers with local and federal laws to focus more towards lowering cost providing quality health care. All of these factors and pieces of legislation can force the hands of stakeholders and there direction of the organization. However it should never be the needs of the stakeholders, provider’s and physicians over that of the patients. 

A stepwise plan in response to the director’s request would be firstly to confer with all local and federal agencies to put in place the proper conditions, ideals and values of worth for incentives. I would begin by informing all physicians of the changes taking place and provide them with detailed presentations and from there gage the interest of those interested and those that are not. From there I would create a board of to oversee the process of the incetives and how they would be allocated and what times they would be allocated after receiving instruction from the local and federal legislators. From there monitoring will commence over the pilot program and there would be opportunity to monitor the old plan to the new plan as not all physicians would want to be apart of the new program. From there, a final decision would be made one way or the other. 

Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Jones & Bartlett Learning: Burlington, MA.