Physician Partners FAQ

The cost savings will come from a reduction in unnecessary hospitalizations and procedures, elimination of redundant studies and testing, improved care delivery and transitions between settings, elimination of duplicative and resource consuming P4P programs and better patient outcomes through application of best practices of care.  In our shared savings agreements, these savings are shared  with HCPP physicians.

How will I get paid?

Generally you will continue to practice under your current billing and reimbursement arrangements with commercial payers and/or Medicare.  In certain scenarios, you may be asked to change your existing contracts with payers to support shared savings arrangements.  For example, some shared savings agreements suggest that primary care physicians are capitated for their services. Our primary goal is to ensure physicians receive higher compensation as a result of their efforts to improve quality and lower overall costs.  Depending on your individual performance related to the quality metrics chosen by the Network Operating Committee, you may receive an annual network quality/efficiency bonus payment to your practice. Your practice may decide to pass this bonus directly to you, or your medical group may elect a different method of distribution.

Typically the payments will be made within 3-4 months following the end of the performance improvement cycle. This interval will be required to review and audit the performance reports and assure that the accounting and performance payments are accurate and complete.

How will my bonus potential be determined?

Your personal potential payment from the negotiated bonus pool for each payer will generally depend on the services you provided for that payer. For example, physicians with more patients in a particular plan would have higher bonus potential than physicians with fewer patients in the plan. That payout will occur if you achieve all of the performance goals applicable to your practice and specialty.

Information technology is a key part of the Network’s success. Our Population Health Management tool collects clinical and operational data from a variety of sources including: 1.) Claims data, 2.) Pharmacy Data, 3.) Hospital and Clinic data, 4.) Reference Labs and 5.) Office “feeds.” This data is “mapped” to patients and displayed to providers who have rendered services to given patients.

Will I be required to purchase or use a Holy Cross Hospital selected EMR?

While a long-term goal would be to migrate all physicians onto the same information technology platform using a Health Information Exchange or shared EHR, this will not be a requirement in the near future. However, membership requirement in the network will likely require the “meaningful use” of an electronic medical record system by the practice (within a designated time frame).

The Population Health Management tool provides each individual physician and their office staff access to a list of their patients that fall into a specific performance reporting category. This list and the practice performance related to each patient is updated on a daily basis.

Is HCPP's Clinically Integrated Network an ACO?

The prerequisite for any ACO is a clinically integrated network that ties together all the clinical components needed to serve a given population. One network, Advocate Physician Partners, serves a population of more than one million people in the Chicago area. Participants in the network work together to collect and analyze performance data, develop clinical protocols, and contract with health plans for pay for performance (P4P) contracts. HCPP has already begun collecting clinical data and generating the performance reporting used to secure contracts with payers. Since we have already secured shared savings contracts designed to leverage our clinically integrated network, we are considered an Accountable Care Organization.

The term "accountable care organization" was coined in 2006 by Elliott Fisher, MD, director of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H. An accountable care organization is a group of payers, physicians, hospitals and other healthcare providers that voluntarily collaborate to provide efficient, high-quality and coordinated care to an assigned population of patients. If providers reduce costs and/or improve specified quality metrics in a certain timeframe, they are able to receive financial rewards from or share in the savings with Medicare or a commercial payer. ¹

1. Molly Gamble and Heather Punke; ACO Manifesto: 50 Things to Know About Accountable Care Organizations www.beckershospitalreview.com. September 03, 2013

Do I need to be exclusive to HCPP?

Primary Care Providers must be exclusive to one ACO.  The measurement of clinical and financial outcomes is tied to a Primary Care Provider’s patient population. As such, Medicare and health plans cannot tie measurement criteria to patients under one physician who participates in multiple ACOs.  Said another way, two ACOs cannot be rewarded for improving outcomes on a single patient. The patient is tied to the PCP and the PCP must be tied to the single ACO. ACOs that  do not require exclusivity from their PCPs may not fully understand how financial incentives are distributed to ACOs. Since patients are not often tied by payers to specialists for Primary Care, specialists generally can participate in more than one ACO.  

Peter Lee, Director of HHS Delivery System Reform stated “ACOs are a big deal! They are a core strategy and CMS wants to move providers into ACO payment……they will experiment with lots of payment forms but fee-for-service payment is dead.” National and local health care expenditures place a huge burden on our economy.  Fee for service payment can promote inefficiency, overutilization and higher costs. Clinical integration is all about improving care coordination for the benefit of our patients and measuring and reporting our quality and efficiency performance. An ACO leverages clinical integration to succeed under a new health care financing paradigm where incentives are aligned around good outcomes and lower health care costs.  If we are to pull off a ‘triple play’ to improve health status, lower costs and improve the patients’ experience then we will need to invest in the systems and organizational structure to do so. The Clinically Integrated Network makes it easier for physicians to demonstrate the quality of care they provide and will simplify quality reporting requirements.

Is Holy Cross Hospital trying to buy my practice or employ me?

Physicians, Boards and CEOs are facing one of the most challenging strategic choices imaginable: maintain their current business model or begin the transformation into a Clinically Integrated Network and ultimately into an Accountable Care Organization. Standing still, however, is perhaps the weakest strategic choice. This is because CMS is beginning to promulgate new ground rules for payment and commercial payers are following suit. Providers who do not invest in the infrastructure to integrate care will be unable to embrace emerging ACO payment methodologies such as medical homes, gain sharing, and pay for performance.

Is it better to be a part of a Hospital sponsored ACO?

Clinical integration is about aligning each part of the health care delivery system to the common goals of improving quality and lowering cost.  Lowering the overall cost of healthcare involves seeking efficiencies in every area, including Hospital costs.  Having a hospital partner invested in the principles of accountable care is far more desirable than not.  For example, we already have put in place processes to help our network physicians identify and reach out to patients who may have sought services from our Emergency Department and who could possibly have sought services in a lower cost setting.  There are overhead expenses associated with ACO operations.  A hospital sponsored ACO is able to leverage existing infrastructure as opposed to the outsourcing and capital investment most often associated with non-hospital sponsored ACOs. Holy Cross Hospital is a non-profit organization founded in 1955 to serve the community.  Guided by our core values, making health care more affordable and therefore providing greater access to care for our community is something we strive to do each and every day.

Please contact Virginia Smith at 954-776-3210 or click here to fill out a contact form.

Will I see better fee for service rates by joining?

Generally speaking our membership requirements are standard to the industry. HCPP needs to be able to collect and share clinical and administrative data from the practice, work collectively on clinical and financial improvement efforts, and implement common information systems in order to participate in shared savings contracts. Physicians participating in HCPP need not have hospital admitting privileges at Holy Cross Hospital. Participation requirements are described in greater detail in the HCPP Network Participation Agreement.

How will this help me and my practice?

HCPP physicians have already found value in participating.  They have been provided a Population Health Management technology platform that provides the vital information needed to assure that patients rely upon them for advice and care to receive the best available service.  Using our data platform allows physicians to have a systematic approach to identifying patients who need care.  Reaching out to those patients can increase fee for service visits, increase patient satisfaction in their treating physician, and increase referrals within the HCPP network. Additionally, our tools can assist HCPP providers with health plan and Medicare Quality ratings such as HEDIS and PQRS. In an era of value based purchasing, being able to prove to patients and payers that HCPP providers deliver high quality care creates a competitive advantage for our network physicians.

The key is to be responsible for your patients as a population, treat them as individuals and be accountable to your fellow partners in this endeavor.  One key shift in thinking is the notion of “Population Health Management.”  Successful networks have physicians who know they cannot sit back and wait for patients to seek care.  Instead, quality is improved and costs are reduced when physicians proactively manage their sick and well patients as a population while caring for them each as individuals. Moreover, physicians in private practice are unlikely to have a large enough patient population to garner the attention of health plans or meet the requirements of CMS without coming together as a group.  ACOs are measured and paid bonuses on group performance.  Because of this, each physician is responsible, not only for their individual success, but also for the success of the ACO.  This is truly a situation where the whole must be greater than the sum of its parts.  The success or failure of an ACO depends upon the buy-in of the participants.  HCPP is structured for success through its physician-led committee structure and engaged physician network.

Will I get more patients?

HCPP physicians have already seen increases in volume as a result of their participation in our network.  One health plan’s population with HCPP physicians grew more than 20% in the first 6 months of the agreement.  Moreover, greater than 4,000 Holy Cross Hospital employees and dependents are encouraged through lower out of pocket costs to seek services from HCPP physicians. Other employers and payers are interested in creating narrow network benefit plans that would steer patients toward the HCPP high value delivery system.

When a new clinical initiative (and its associated performance measures) is introduced, the Network Performance Improvement Team provides physicians and their staff educational sessions regarding the initiative and the best means (guidelines/ protocols) for achieving success.  Our current clinical care guidelines are available for review on our website.

What will this Population Health Management tool cost my practice?

Participation in the Network is voluntary. One guiding principle of the network leadership is “first do no harm”. This means, don’t create policies or procedures or take actions that threaten or damage the integrity, reputation or viability of any of the participating practices. The purpose of the network is to create provider collaboration towards improving the health of the community through improvements in the quality and efficiency of care.