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Novel Approach to Improving Cardiovascular Care
Date:10/5/2007

ase. If a physician in one of Montefiore's ambulatory care centers meets certain clinical performance standards for her patients (such as controlling high blood pressure, checking weight, providing nutrition counseling, checking smoking status, and giving a flu vaccine), she could earn an income bonus. The higher her score is on the list of performance standards that are recorded electronically, the larger the bonus -- up to a certain maximum. The same type of financial incentives, with different performance criteria, would apply to treating patients with existing heart disease or diabetes.

"This approach aligns the incentives for patient, physician and hospital in order to promote best practices and optimal outcomes," said Safyer.

Montefiore will use its unique clinical information system to quantify performance.

In the more complex environment of an inpatient hospital setting, performance measurements will go beyond clinical data to include the number of readmissions for heart care patients within a year's time and patient satisfaction survey scores.

"This project breaks new ground," said Rohit Bhalla, MD, Chief Quality Officer at Montefiore. "Most pay-for-performance experiments are conducted by insurers, not providers. Providers generally do not have an incentive to reduce utilization."

"Montefiore is uniquely positioned for this grant," said Stephen Rosenthal, president of Montefiore's CMO, the Care Management Company. "We have a pioneering care coordinating program (Care Guidancesm) for 150,000 Bronx patients for whom we are not only the provider, but also act as an insurer. Therefore, we have an alignment of all the right incentives to improve quality and optimize appropriate utilization for these patients. Most hospitals have not adopted at-risk arrangements such as this, which has very similar incentives to the pay-for-performance model."

Unique aspects of the Montefiore pay-for-performance grant:

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SOURCE Montefiore Medical Center
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