Pediatrics Incentive Description
SIP’s Board of Directors developed an incentive program in 2002 when SIP’s year-end financials were favorable. In late 2011, the SIP Board of Directors decided to redesign the Incentive Program to align the incentive measures with the goals of SIP. Patient Satisfaction projects and involvement with the Sutter Community Connect (EPIC) eHR were added, along with a few selected HEDIS measures. There are separate HEDIS measures for adults and peds.
The incentive plan, now known at the Performance Compensation Plan, changed in 2017 and is outlined in the documents below for both PCPs and Specialists. Physicians must now complete one meeting every six months in order to qualify for that incentive period (Mid-Year: January – June and Year-End: July - December).
Please take a few moments to read about the changes to this program and how it will impact you. Please note: Any distribution through the Incentive Program is contingent upon SIP’s overall financial performance and applies to all SIP physicians.
- High potential for quality awards using revised metrics
- Patient satisfaction surveys based upon iPad, email, and text surveys using “Would recommend”
- SIP will pay you to go to virtual journal clubs or dinner meetings to foster the joy of medicine
- One innovation project every 6 months
- One member meeting in each 6 month period is required to receive the incentive award for that period.
- All amounts below are yearly, paid in two installments
The board agreed that SIP must continue to aggressively improve its quality metrics to benefit patient care as well as to maximize SIP and practice income. The pediatric metrics have been revised so that one or two families will not have a disproportionate effect on the awards.
The maximum for quality is estimated to be about $67K, divided among BP screening, testing for strep pharyngitis, flu vaccination rate, developmental assessments, and access. Adjusted by patient volume factor*.
As you know, SIP has switched to tablet based surveys (also using email and text messages) and we can now survey ALL your patients so that every practice should have enough responses to understand how they are doing and to participate in this portion of the SIP incentive. Each physician will receive an award based upon the “would recommend” question. The maximum award will be ~$15K for performance at the 90th percentile, decreasing to ~$2K at the 15th percentile. 20 surveys every 2 months are required to earn the maximum award. Adjusted by patient volume factor*.
In recognition of the importance to SIP of a unified medical record, SIP continues to award to those practices who have deployed SCC an amount equal to the monthly SCC license fees plus $3K. Not adjusted by patient volume factor.
In addition to $300 2x/yr for completing a wellness survey, SIP promotes physician collaboration and camaraderie by paying for SIP physicians’ virtual dinners at journal clubs, practice meetings, and/or discussion meetings that include wellness, up to $40 each, once every 2 months. Not adjusted by patient volume factor.
SIP encourages innovation projects that improve quality, patient satisfaction, and/or physician wellness – other great ideas are welcome also. You can do one project every 6 months. Adjusted by patient volume factor*.
An additional ~$100 for each patient successfully completing:
- HPV vaccination of adolescent boys (2 or 3 by age 13)
- HPV vaccination of adolescent girls (2 or 3 by age 13)
- Tdap for adolescents
(Not adjusted by patient volume factor)
^BP measurement as documented at well child visits: ages 3-17, visit codes 99382, 99383, 99384, 99392, 99393, or 99394 using CPT2 codes if not on SCC – see chart below.
^^ SIP collects influenza vaccination data from claims. We will not receive the data If your patient had their flu shot at a pharmacy or other outside provider. To receive credit please submit a CPTII code (4274F) on your claim with a $0.01 charge. A copy of the record should be scanned into the patient chart.
^^^Developmental assessments, both for development and autism: the metric captures documentation as kids age, with increasing number of screens in older kids. Full performance is 3 screenings in 3 years, but practices are not expected to achieve this in 2019 as we begin. This goal may change in future years.
Developmental screening target is one at about 9 months, 18 months, and 24-30 months, use PEDS or other validated tool, and ASD screening around 18 and 24 months using M-CHATS or other validated tool. When appropriate, two screenings can be done and coded at the same visit. Numerator: number of assessments coded as 96110 (use 2 units for two screenings); denominator: each child who is 12-18 months old at the time of measurement and who has been in the practice for at least 9 months, plus 2 x each child age 18 – 24 months in the practice for at least 15 months, plus 3 x each child age 24-36 months in the practice for at least 21 months. Since the number of screenings may take 2 years to reach target, awards in 2019 are based on percentile rank within SIP rather than percentage completed.
All amounts are subject to change based upon the availability of funds.
To receive a performance compensation payment physicians must meet minimum standards:
- Attend one meeting in each half year to receive an award for that period. $300 per meeting will be awarded to PCPs and specialists for each designated meeting attended, except for duplicated PCP meetings. Member meetings are available for both PCPs and specialists.
- All PCP’s are eligible through their initial partial calendar year and first full year of practice for an incentive payment, after which 50 attributed patients are required.
*The PCP patient volume factor is 1.0 for unique SIP patient volumes = 350, decreasing arithmetically to 0.5 for a unique SIP patient volume of 50. Volumes above 350 receive proportionately larger awards.
** The actual cost of a monthly SCC contract is calculated as average of the total cost for all qualifying physicians in a practice.
Performance Compensation Program awards are not guaranteed and are dependent upon SIP’s financial performance.
2021 Printable Incentive Documents
- 2021 Mid-Year Incentive - Pediatrics (Updated 10/8/21)