Status of Hospitalist Group Leaders' Knowledge of Hospital Participation in Payer to Hospital Pay for Performance Programs

Background:

Hospital participation in pay‐for‐performance (P4P) programs with payers provides an opportunity for aligning incentives between hospitals and hospitalists. These programs may prompt hospitals to reward hospitalists for compliance with performance measures specified in payer‐to‐hospital P4P contracts. The purpose of this survey is to assess the current knowledge of hospitalist group leaders regarding hospital participation in P4P programs and to characterize these P4P programs.

Methods:

In the fall of 2006, hospitalist group leaders were surveyed to capture information about their knowledge of their hospital's P4P programs involving payer to hospital incentives.

Results:

Twenty‐nine percent of respondents (42 of 146) reported that their hospital participates in a P4P program, 56% (82 of 146) reported their hospital does not participate, and 15% (22 of 146) were unsure. The P4P program sponsor for 26% of respondents was a Blue Cross plan, for 19% of respondents a local/regional health plan, for 11% a national plan, for 11% CMS, and for 2% Medicaid; 32% were unsure of the sponsoring payer. For those group leaders reporting their hospital's participation, 37% reported participation in 1 P4P program, 14% in 2 programs, 5% in 3 programs, more than 40% participated in greater than 3 programs, and 5% were unsure how may programs. Regarding participation in a national initiative, 19% reported participation in the Premier Initiative, 19% participated in Leapfrog, 23% in neither Leapfrog nor Premier, and 38% were unsure if their hospital was participating in a national P4P initiative. Thirty‐eight percent reported that the financial arrangement for the P4P program was paid based on a percentage of total reimbursement, 6% reported a flat payment, 9% indicated another financial arrangement, and 47% were unsure of financial arrangement. In terms of incentive alignment, 39% of the time the hospitalist group shared a specific performance measure as part of its incentive program with the payer‐hospital P4P program.

Conclusions:

Despite the growing prevalence of payer‐to‐hospital P4P programs, there is a lack of knowledge by hospitalist leaders about their hospital's participation in these programs. In a minority of instances, 39%, there was alignment of specific incentives between sponsoring payers and the hospital, and between the hospital and hospitalist group.

Author Disclosure:

W. Whitcomb, none; P. Torcson, none.