With modifications moving a national reimbursement system from volume-centric to performance based and challenges created by an overburdened Medicare and Medicaid system, times must change. The question is, "Who will lead that change?"

 

Holy Cross Physicians Partners (HCPP) in Fort Lauderdale was established with the vision that a physician-led response is the answer and last month it began recruiting physicians into a clinical integrated network

 

All HCPP decisions will be made by a physician-controlled operating committee composed of independent physicians as well as primary care and specialty physicians employed by Holy Cross Hospital in Fort Lauderdale. By HCPP bylaws, sub-committees in quality, finance, contracting and credentialing will also be physician-led.

 

In creating HCPP, we looked at several models including Advocate Physician Partners in Illinois, which signed its first commercial Accountable Care Organization (ACO) contract with the largest insurer in Illinois just over one year ago.

 

Unlike an ACO, HCPP will focus on the commercial payer market while developing the necessary infrastructure to enable it to evolve into an ACO that can accept and manage Medicare enrollees should it one day elect to do so.

 

A Model For Integrating Independent Physicians Into Accountable Care Organizations by Mark C. Shields, Pankaj H. Patel, Martin Manning and Lee Sacks published in Health Affairs, 2011 noted in its conclusion, "A physician-hospital organization such as Advocate Physician Partners, with 2,700 independent practice physicians, can win market and regulatory acceptance; reduce costs; improve health outcomes; be held accountable for outcomes; incorporate payment mechanisms that reward value instead of simply volume; and report outcomes to the public."

 

The study also noted that partnering with hospitals in creating such organizations can be beneficial. Holy Cross Hospital is providing the startup capital and infrastructure for HCPP.

 

Physicians will oversee the negotiation of contracts as HCPP seeks contracts that provide appropriate base-rate compensation with additional performance-based bonuses and incentives. HCPP physicians will determine the targeted quality metrics and the distribution of the performance dollars.

 

Participants will continue to practice under a fee-for-service arrangement with commercial payers. A participant’s personal potential payment from the negotiated bonus pool for each payer will generally depend on the services provided for that payer. It is often based on charges as a percentage of the total services provided to the payer by the Network.

 

Depending on a participant’s individual performance related to the quality metrics chosen by the Network Operating Committee, he or she will receive an annual network quality/efficiency bonus payment to the participant’s practice. The practice may decide to pass this bonus directly to the participant or elect a different method of distribution.

 

Participants in HCPP agree to: the collecting and sharing of clinical data; working on clinical improvement efforts; a willingness to adopt a common technology portal to report the data; participating in pay-for-performance contracts; and abiding by agreed upon requirements for clinical practice.

 

When a new clinical initiative and its associated performance measures are introduced, a network performance improvement team will provide physicians and their staff in person and web-based educational sessions regarding the initiative and the best means for achieving success.

 

The keys to success for achieving most performance goals will be to (1) understand the science and reasoning behind each initiative protocol or guideline; (2) train and empower office staff in identifying patients needing services or interventions related to the initiative; and (3) track and plan to progress against goals.

 

Information technology will be a key part of HCPP’s success and will utilize a clinical performance reporting system which will make data easily accessible for physicians and their office staff on the web.

 

Medical cost savings will come from a reduction in hospitalizations, elimination of redundant studies and testing, elimination of multiple pay for performance programs and better patient outcomes through application of best practices of care.

 

HCPP is open to independent physicians as well as those employed at Holy Cross and is actively recruiting for the next six months.