Question

Sunnyvale Primary Care (SPC) is considering a P4P program to increase preventative care for its

diabetic patients. HbA1c is a blood test used to determine how well diabetes is being controlled.

The state medical asociation recommends that diabetic patients have this test a minimum of two

times per year. In addition, because patients regularly enter and leave primary care practices, the

association considers that a level of 90 percent of diabetic patients have a HbA1c test two times per

year is a reasonable goal for most primary care practices. In the state where SPC is located,

currently only 80 percent of diabetic patients actually have a HbA1c test two or more times per year.

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 $5000 bonus if:

- the percent of their diabetic patients that had at least two HbA1c tests in the past six months 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 six months 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

six to the previous six months months 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 1

a..
1. > the state av. of 80 percent (relative performance)
Jul-Dec
Physician	%	% >80%	Allocation of $ 5000 Bonus at the rate of % > 80%
A	76%	0	0/13%*5000=	0
B	81%	1%	1%/13%*5000=	385
C	81%	1%	1%/13%*5000=	385
D	91%	11%	11%/13%*5000=	4231
		13%		5000

2. > the state goal of 90 percent (benchmark performance)
Jul-Dec
Physician	%	% >90%	Allocation of $ 5000 Bonus at the rate of % > 90%
A	76%	0	0	0
B	81%	0	0	0
C	81%	0	0	0
D	91%	1%	1%/1%*5000=	5000
				5000

3. Improvement performance
Physician	Jan-Jul	Jul-Dec	Diff/improvement%(Col3-Cl 2)	Allocation of $ 5000 Bonus at the rate of % > 90%
A	60%	76%	16%	16%/29%*5000=	2759
B	70%	81%	11%	11%/29%*5000=	1897
C	80%	81%	1%	1%/29%*5000=	172
D	90%	91%	1%	1%/29%*5000=	172
			29%		5000

b. Allocating rewards, as per " Improvement performance" is recommended as it's rewards recognise the efforts taken as well as the work being done by the physician --that will certainly improve the scenario , even further--when the state goal will be achieved or even exceeded.

That way , those physicians, who are not able to achieve the 80% or 90% mark straight-away, due to a variety of reasons----

such as their area of operation,prevalence of diabetes in the area,physician's personal & family reasons & the like---

will get rewards commensurate to the efforts put in by them or work done---without losing the whole lumpsum.