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November 2013
Some Physician Group Incentive Program specialty practices eligible for fee uplifts in 2014
Fee uplift available to doctors recognized in Hospital Collaborative Quality Initiatives
The seven hospital-based Collaborative Quality Initiatives listed below have been selected to participate in our CQI physician recognition reward program. The CQI physician recognition program rewards participating site physician champions and physician leaders that are highly engaged in CQI activities.
Each coordinating center develops a “physician index” specific to its CQI that consists of measures aimed at evaluating active participation. Each CQI nominates engaged physician champions and physician leaders who meet or exceed a threshold on the physician index. The nominated physicians will be eligible for 2 percent fee uplifts for the same procedure and clinical service codes used for the PGIP specialist fee uplifts. The recognition uplift will apply to fees from Feb. 1, 2014, through Jan. 31, 2015.
Physicians may receive these recognition payments in addition to any PGIP performance-based fee uplifts as described in the article at left. As background, in 2013, we applied the CQI recognition uplift to a limited number of evaluation and management services codes. In 2014, we will apply the CQI recognition uplift to most procedure codes, except those for ambulance service, durable medical equipment, prosthetics and orthotics, anesthesia, immunizations, hearing, vision, lab, dental and most injections.
The following CQIs are taking part in the recognition reward distribution for 2014:
- Blue Cross Blue Shield of Michigan Cardiovascular Consortium — Percutaneous Coronary Interventions
- Blue Cross Blue Shield of Michigan Cardiovascular Consortium — Vascular Interventions Collaborative
- Michigan Surgical Quality Collaborative
- Michigan Bariatric Surgery Collaborative
- Michigan Trauma Quality Improvement Program
- Michigan Anticoagulation Quality Improvement Initiative
- Hospital Medicine Safety Consortium
For more information, please contact our CQI administrative team at CQIPrograms@bcbsm.com.
Specialty practices that participate in the Physician Group Incentive Program may be eligible for fee uplifts for services performed from Feb. 1, 2014, to Jan. 31, 2015. Specific criteria apply, and practices must be nominated by a PGIP physician organization by Nov. 12, 2013.
PGIP member practices in the following specialty areas will be considered for the fee uplifts:
- Allergy
- Cardiology
- Chiropractic
- Critical care
- Emergency medicine
- Endocrinology
- Gastroenterology
- Infectious disease
- Neonatal care
- Nephrology
- Neurology
- Obstetrics and gynecology
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- Oncology
- Orthopedics
- Otolaryngology
- Pain management
- Physical medicine
- Podiatry
- Psychiatry
- Psychology
- Pulmonology
- Rheumatology
- Sports medicine
- Urology
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To receive the uplift, the following criteria apply:
- Practitioners in a practice must be a member of a physician organization participating in PGIP as of Aug. 1, 2013.
- At least one PGIP physician organization (or two in some cases) must nominate each specialty practice.
- Once nominated, specialist practices must meet performance metric rankings developed by Blue Cross Blue Shield of Michigan.
PGIP POs can nominate specialist practices that:
- Include at least one practitioner from one or more of the 24 eligible specialties
- Have signed a Primary Care-Specialist Agreement with their PO
- Have displayed a high level of engagement with the PO
- Are actively involved in managing and optimizing the use of services and quality of care
- Are partnering with primary care physicians to improve care processes and coordination
PGIP physician organizations must submit nominations via the PGIP Collaboration SharePoint site by Nov. 12, 2013. Information about the nomination process was provided to the physician organizations through webinars and related documents.
Nomination by a PO does not guarantee that a practice will be selected for a fee uplift. The selected practices will receive a fee uplift for one year — from Feb. 1, 2014, through Jan. 31, 2015. The nomination and selection process will be repeated annually.
Blue Cross will rank practices using population-based metrics. The top third of nominated adult specialty practices and nominated neonatal care practices will receive a10 percent fee uplift, and the middle third will receive a 5 percent fee uplift. Nominated pediatric specialty practices will receive a 10 percent uplift.
In 2013, we applied the specialist fee uplifts to a limited number of evaluation and management service codes. In 2014, we will apply the specialist fee uplifts to most procedure codes, except those for ambulance service, durable medical equipment, prosthetics and orthotics, anesthesia, immunizations, hearing, vision, lab, dental and most injections.
Oncologists who are not selected for performance-based fee uplifts are eligible for a 5 percent fee uplift if they do one of the following:
- Participate in both the Michigan Oncology Clinical Treatment Pathways Program and the Michigan Oncology Quality Collaborative.
- Achieve certification through the Quality Oncology Practice Initiative.
For more information, contact your provider consultant.
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