Healthy Incentive

Pay for performance has every medical provider moving toward the common goal of providing a higher quality of health care.

Last week, Univera Healthcare announced it awarded 47 upstate hospitals $24.5 million in quality improvement incentive payments. In the past 10 years, Univera has awarded more than $169 million as part of its Hospital Performance Incentive Program.

“With all the changes in health care brought about by the Affordable Care Act, we applaud our hospital partners for continuing to focus on improving the quality of care and patient safety,” said Carrie Frank, Univera Healthcare vice president of quality and health informatics.

Participating in the program in 2013 were 15 Western New York hospitals and health centers, including WCA Hospital. Dr. Marlene Garone, WCA Hospital vice president of medical affairs, said in contracts with health insurance providers, WCA Hospital officials negotiate a pay-for-performance percentage. She said the pay-for-performance system is based on three standards: safety, quality and efficiency.

“We select targets for improvement. If we meet those targets, we receive the incentive. If we don’t meet them, we don’t receive the incentive,” she said.

Since the first pay for performance agreement in 2005 with Univera Healthcare, Garone said WCA Hospital has received 75 to 100 percent of their incentive payment each year.

“The goals are not easy goals. They require statistical improvements,” she said. “With improvement, it makes each year’s goal more and more difficult to reach.”

Garone said she cannot release how much the hospital received from Univera Healthcare in a performance incentive payment. However, she said the money goes to hospital operations.

“The incentive goes toward quality initiatives. We are a nonprofit provider – all resources go back to the care of the patient,” she said.

Launched in 2004, Univera Healthcare’s incentive program evaluates participating hospitals on more than 250 performance measures. In 2013, hospitals achieved 89 percent of all target quality levels. In addition to required clinical and patient safety measures, other nationally endorsed measures and target outcomes are jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, The Joint Commission, the Institute for Healthcare Improvement and others.

Areas targeted for improvement include:

Clinical processes of care – focused on improvements in heart attack care, heart failure, pneumonia and surgical care.

Patient safety – centered on reductions in hospital-acquired infections, falls, pressure ulcers, readmissions and other adverse events or errors that affect patient care.

Patient satisfaction – using the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.