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    Tackling the tricky task of dividing quality bonus payments

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    How do doctors divide compensation that comes into a medical practice in bulk? Who deserves how much money when that money is paid based on quality, citizenship, emergency room visits, timely hospital follow-up appointments, utilization and access to care? Does the doctor that works night hours get more than the doctor that has no night hours? Does the provider who gave the most flu shots get a bigger share than the one that didn’t? Should the provider who had the most hospitalizations be penalized? Should the doctor whose patient had the most expensive and prolonged chemotherapy trials be dinged?


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    These are interesting scenarios that come into play with the current state of healthcare payments, which can be bundled or bonused, big or little, and are often coming in at unpredictable times and in unpredictable amounts and sometimes based on confusing metrics.Lori Rousche, MD

    In our group practice, we have had some serious and at times contentious discussions regarding splitting up money that comes in as a bonus to the group, rather than as a fee-for-service payment. Most recently, the insurance group that we are contracted with paid out two bonuses. One was based on quality metrics, over which providers have some control. The other was based more so on utilization, over which we often have very little control. And when I say this, I am speaking more about expensive cancer treatments and recurrent prolonged hospital stays.

    With the advent of CPC+ and the increased outreach to our sickest patients, we certainly hope to decrease our ED visits and recurrent hospital visits. However, if your panel of patients has two active lung cancers and say, a liver transplant, you are out of the bonus money. 


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    We have seven offices that each were awarded their quality money as an individual office. None of this money was shared with the other offices, because each office works as its own profit center. As a larger group, we felt it would be fairer to keep the quality bonus within the individual offices where it was divided between partners as the members of that office thought fit.

    Next: Need to understand how to deal with insurance changes


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