| 9/1/14 | UNDERSTANDING HEALTHCARE FINANCIAL MANAGEMENT |
| | | Chapter 3 -- Payments to Providers |
| PROBLEM 1 |
| Sunnyvale Primary Care (SPC) is considering a P4P program to increase preventative care for its |
| diabetic patients. HbA1c is a blood test used to determine how well diabetes is being controlled. The |
| state medical association recommends that diabetic patients have this test a minimum of two times per |
| year. In addition, because patients regularly enter and leave primary care practices, the association |
| considers that a level of 90 percent of diabetic patients having a HbA1c test two times per year is a |
| reasonable goal for most primary care practices. In the state where SPC is located, currently only 80 |
| percent of diabetic patients actually have a HbA1c test two or more times per year. |
| SPC decided on HbA1c as a process measure for its P4P program and is now considering three |
| methods of allocating rewards. For each of the measures below, a physician receives a $5,000 bonus if: |
| - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater |
| than the state average of 80 percent (relative performance). |
| - the percent of their diabetic patients that had at least two HbA1c tests in the past year is greater |
| than the state goal of 90 percent (benchmark performance). |
| - the difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year |
| compared to the previous year is greater than 10 percent (improvement performance). |
| The percent of diabetic patients that had at least two HbA1c tests in the past year for each SPC physician |
| is shown below: |
| Physician | Jan-Jun | Jul-Dec |
| A | 60% | 76% |
| B | 70% | 81% |
| C | 80% | 81% |
| D | 90% | 91% |
| a) For the Jul-Dec period, what would be each physician's P4P if rewards were allocated based on |
| relative, benchmark, and improvement performance? |
| b) Which method(s) of allocating rewards would you recommend? |
| ANSWER |
Barbara79
Chapter03withProblem01.xlsx
