Near the end of fiscal year 2023, changes were announced to the Clinical Partner compensation programs for both physicians and APPs. One notable change was the direction to replace the patient experience value-based measure (VBM) with a clinical documentation compliance value-based measure, within the value-based incentive for both physicians and APPs. Since then, our teams have been working on establishing back-end reporting, PPMT visibility, and a host of other required elements in order to operationalize VBMs like this one.

VBM: Clinical Documentation Timeliness

Clinical documentation timeliness was chosen as a metric because of the positive impacts it has on:

• Coordination of care
• Patient engagement in visit and health information
• Decreased turn around for referrals and coordination with health care facilities or legal needs
• Regulatory obligations
• Reduction in delayed payments for care delivered

The VBM is designed to measure note completion within 48 hours, in support of the CentraCare Delinquent Documentation policy. The delinquent documentation policy does apply enforcement measures if notes are documented past 14 days. This VBM has been designed to complement enforcement measures by incentivizing exemplary work in completion of notes within 48 hours.

Please note that no new documentation initiatives/requirements are being introduced.

Specific notes that are included in the measurement are (all encounters where below note type utilized, otherwise referred to as ‘Eligible Visit Events’):

• Clinic Progress Note (includes Perinatology and Chemical Dependency)
• H&P (Clinic Pre-op, MAW, wee, Adult Annual Physical)
• Consult Note
• ER Note
• H&P Hospital Admission
• Discharge Summary

Measures and Goals

Clinical Partners will be measured as individuals for the VBM, and consistent with CentraCare’s value-based incentive design there will be three goals and associated payouts: Minimum 1%, Target 1.5% and Stretch 2%.

 The first step to determine individual progress with the Clinical Documentation VBM is to identify which group one belongs to/set of goals one is trying to achieve by June 30, 2024. There are two groups:

(The Group 2 Stretch Goal is intentionally equal to Stretch performance for Group 1, making Stretch award equivalent with Stretch performance.)

Measurement Mechanics

Denominator — All notes as defined in the ‘Eligible Visit Event’ section above.
Numerator — All notes that were completed within the 48-hour timeframe outlined in the ‘Eligible Visit Event’ section and are present, meet criteria, and includes a signature with title, date, and time.
Exclusions — Unexpected/Emergency Leave (i.e. medical leave, FMLA). Also, Deficiencies created due to clerical errors in documentation requiring no modification.

Measurement will begin October 1, 2023, and end June 30, 2023. In future years that the VBM is still in place, measurement will include the entire fiscal year.

Baseline Data

To identify which set of goals are applicable to individual Clinical Partners for FY24, use this link: FY23 Baseline Data List.pdf

Our Compensation Team continues to work diligently to get data uploaded and available in PPMT. Once uploaded, goals will be viewable along with current data. However, Clinical Partners and Leaders are able to access historical and current data by utilizing this link 1205020 Clinical Note Documentation – Power BI to the Power BI Report that will be feeding PPMT. Once data is available in PPMT, Clinical pPartners and Leadership will be notified through normal communication avenues. 

When the Clock Starts

Questions have surfaced about when “the clock” starts and stops for this measure. The simple answer is that Clinical Partners have the date of service (DOS) as well as two days after the DOS to complete documentation. Weekends and Holidays are included in this calculation. 

 A link to the measure specification can be found here Clinical Documentation Compliance Measure_FY24.pdf.

Please Review

Please review this information, be open, and communicate questions and concerns to your leaders. Please keep the following in mind: 

• The same calculation was used for the FY23 baseline data and 81% of clinical partners are in Group 1 (compliance of > 80%) 
• Clinical documentation timeliness was chosen as a metric because of the positive impacts it has on:
  • Coordination of care 
  • Patient engagement in visit and health information 
  • Decreased turn around for referrals and coordination with health care facilities or legal needs 
  • Regulatory obligations 
  • Reduction in delayed payments for care delivered 

The Clinical Measures Sub-Group (CMSG), chaired by Dr. Sean Wherry, is the steward of this measure. As work continues to operationalize this measure, questions and concerns can be sent to Lisa Porter at PorterE@centracare.com. Lisa can assist in answering questions and raising concerns to the appropriate level.