The Challenge of Aligning Physician Compensation with Quality/Value Metrics

Meg Barbor, MPH

June 2016, Vol 6, No 6 - COA Meeting Highlights

“Value is the buzzword of medicine in 2016 and going forward,” said Lucio Gordan, MD, a hematologist/oncologist at Florida Cancer Specialists & Research Institute, who led a panel discussion at the 2016 Community Oncology Alliance annual meeting.

The panel discussed the hurdles oncology practices face in making the transition toward quality- and value-based reimbursement, as well as some of the salient issues in the business of oncology in 2016.

The Value Challenge

“Value is outcome divided by cost,” said Dr Gordan. “Cost is cost; it’s easy to figure out. The question is, what is outcome? And how can we ever agree on what it is, and how to measure it?”

“We all know that outcome should be centered on the patient,” he said. However, the problem arises when deciding whose outcome will be selected, because each stakeholder wants a different outcome.

“So who defines value?” Dr Gordan asked. It is probably not a good idea for the government to define value, he said. “Should we, the community oncologists, actually define value, since we take care of 80% of the patients with cancer in our country? That’s probably the answer.”

According to Dr Gordan, the 4 major challenges in the pursuit of value-based care are:

  1. Baby boomers will, by sheer volume, cause increases in utilization and cost.
  2. A huge shortage of healthcare providers will “make it very difficult to maintain quality outcomes and get the job done,” he said.
  3. “Third, with the wonderful explosion of knowledge and the development of new drugs such as biologics, we as oncologists, patients, families, and industry are all rejoicing for good reason. However, we are all aware of the price tag associated with the innovation in oncology care, and a serious discussion and determination of the true value of drugs will have to happen in the near future.”
  4. The ever-growing cost of hospitalizations, and the fragmentation of care, particularly toward the end of life, has added financial anxiety and distress to individuals, to corporations, and to the government, he added.

The landscape is rapidly changing, and physicians need to be in charge of benchmarking. “We have to be able to use the metrics to improve care, safety, and efficiencies, and to potentially contain costs,” Dr Gordan said.

“I remain convinced that value will always be best achieved in the community setting,” he emphasized. “We have all the elements, the energy, and the partnerships to make this happen.”

Aligning Reimbursement and Quality Care

Rich Schiano, MBA, Chief Executive Officer, Oncology Hematology Care, Cincinnati, OH, described the experience at Oncology Hematology Care. “We brought in an outside consultant to help us formulate our compensation plan and look at quality as a component of it,” said Mr Schiano. They surveyed physicians and built a metric related to specific measures associated with satisfaction, compliance, community outreach, and adherence to pathways. The measures were then added for advance practice providers.

“What we’re trying to do is to align the key metrics to those things that are going to best serve the care of our patients, and to also ensure that we’re being compensated appropriately for what we’re doing,” Mr Schiano said.

Michael Diaz, MD, oncologist, and Todd Schonherz, Chief Operating Officer, Florida Cancer Specialists & Research Institute, explained how their practice, Florida Cancer Specialists, has tackled the undertaking that is “creating value.”

According to Dr Diaz, for an entire practice to succeed, appropriate infrastructure must be developed so that physicians have all the tools necessary to deliver optimal quality and value.

In 2015, Florida Cancer Specialists launched a care management program, which provides 24 hours a day, 7 days a week access for patients.

“We’re still in the process of defining value, and people are still debating the optimal quality measures, and we don’t want to focus on moving targets,” Dr Diaz said. “But overall, we’d like to make it so that every physician has the opportunity to succeed, and we would hate to take the approach of sacrificing compensation if they’re not able to meet certain metrics, because there’s no reason they shouldn’t be able to meet all the metrics in the first place.”

Mr Schonherz said that although there is no compensation formula in place at Florida Cancer Specialists that directly correlates to value measures, value services, such as adherence to National Comprehensive Cancer Network guidelines, have been in place from the beginning.

“We have a goal of helping to address education, making proactive calls, and working to avoid unnecessary hospitalizations,” Mr Schonherz said. “We’ve created a virtual tumor board, we have a number of clinics with extended hours, and we’re piloting a walk-in clinic later this year in Fort Myers,” he added.

“Last year, we completed almost 90,000 patient surveys, and we put our money where our mouth is: our compensation was based on our ability to drive customer satisfaction, how patients perceive us, and how we treat them day in and day out.”

Randy Broun, MD, President and Chairman of the Board of Directors, Oncology Hematology Care, Kenwood, OH, explained how his clinic has been working to adapt to the transition at Oncology Hematology Care, including a complete redesign of their computer system, with a built-in component for quality starting at 5%. The 5% was divided across 5 different quality measures that each physician is expected to achieve, with 1% associated with each of those measures. Dr Broun emphasized the importance of tailoring the measures by specialty: metrics for medical oncologists may not fit radiation oncologists.

“We tried to choose achievable guidelines, and we largely succeeded; most people got their 5%,” said Dr Broun. He added that Oncology Hematology Care is involved in value-based programs with several of the large payers, and clinical guidelines will become aligned with payers’ requests in the future.

The Volume-to-Value Movement

Mr Schonherz said that transitioning to value-based reimbursement is a marathon, not a sprint. “We’ve had productive discussions with all the large payers over the past year, but these are not simple agreements to enter into, as there are a lot of analytics involved,” he said. “It’s going to take some time to develop these new programs, and to have the baselines we can all support, to make sure we’re going to be here for the long-term for our patients.”

When asked how to deliver these metrics easily to providers, Mr Schiano said he hoped to build a level of real-time transparency that would allow doctors to see how they are performing against these metrics. “My vision is that in each practice site, the entire practice is aware of how we’re performing at a local level in terms of patient satisfaction.”

He said that data are an important driver. “If you have the data that can demonstrate that you’re operating within pathways, you’re delivering cost-effective care, and you have tremendous patient satisfaction, you’ll be operating from a position of advantage. So our goal is to have a robust database that we can use with our partners, to ensure that we’re working in harmony as opposed to at each other’s throats,” Mr Schiano said.