Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds.
THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
Money and Incentive Pools
By Brent A. Metfessel; MD, MS
Some Managed Care Organizations [MCOs] use medical provider profiles to allocate funds to the top-performing physicians. The MCO may give additional bonuses or preferential allocation of incentive pool funds to providers that perform well on particular cost-effectiveness and quality indices.
Incentive Pools
Incentive pools are often built based on a certain percentage or “withhold” of dollars that are taken from the providers’ usual reimbursement and placed in a pool. Top performers would be allocated the greatest percentage.
Example:
One mid-sized health plan in the Southeast paid a 20% bonus to providers with a case-mix adjusted performance ratio (actual/expected cost) of less than 1.3. Although such allocation schemes might incent providers to practice efficiently and with high quality, the MCO should attempt provider education as to the most appropriate practice patterns for the first one to two years after new profiles are introduced. This education should occur prior to introducing monetary incentives, since otherwise the relationship between providers and MCOs may ultimately become strained.
Assessment
Unfortunately, money can become a major point of contention between providers and between providers and the health plan.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do your bonus pools work; or should work? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
Get our Widget: Get this widget!
Our Other Print Books and Related Information Sources:
Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Sponsors Welcomed
And, credible sponsors and like-minded advertisers are always welcomed.
Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise
Share this:
Filed under: Career Development, Healthcare Finance, Practice Management, Quality Initiatives | Tagged: Brent A. Metfessel, HMO, incentive risk pools, Managed Care Organizations, MCO, medical reimbursement, medical reimbursement witholds, P4P, risk pools |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Dr. Metfessel,
This may be an example of “Little’s Law” – sometimes referred to as the first fundamental law of system behavior.
In other words, when more and more inputs are put into a system, such as more patients and an additional nurse employee – and when there is variation in their conditions, illness or treatments – there becomes an exponential rise in “cycle time.”
Productivity of the system begins to fall and inefficiency and variation creeps in.
This complicates the physician bonus situation, greatly.
Loman
LikeLike