"US Healthcare Solutions
provided us with access to a national payor and guided us through
the complexities of developing and obtaining funding for a
Pay for Performance (P4P) program. Now
in its second year, the program is a positive change for the
Client: Doylestown Hospital
Richard Reif, President and CEO, Doylestown Hospital
Doylestown Hospital made a strategic decision in 2001 to invest
in systems designed to improve patient safety and outcomes.
Key to the plan was the creation of the Improving Systems Leadership
Team (ISLT), chaired by President and CEO Richard Reif and
consisting of physicians, nurses, administrators and others
who provide healthcare services in the hospital.
More than a dozen initiatives are managed by the ISLT process,
resulting in a gradual reduction in Length of Stay (LOS) for
the 200-bed community hospital.
The reduction in LOS, combined with single-digit hospital
margins and potential revenue losses due to per diem reimbursement,
placed the hospital and its ISLT program in a Catch-22 situation.
Improvements in patient safety and quality had the potential
to harm the hospital financially.
After a few years of successful implementation of quality
initiatives, the hospital was unsuccessful in beginning a dialogue
with a major insurer to amend its contract with a P4P component.
US Healthcare Solutions was engaged to explore opportunities
for establishing a dialogue and developing a strategically-directed
relationship with selected payors.
Over the course of a few months, Aetna, members of Doylestown
Hospital’s ISLT and US Healthcare Solutions developed
a Pay for Performance program that incorporated the hospital’s
quality efforts and was consistent with Aetna’s performance-based
contracting philosophy. The end result was a multi-year agreement
to reward improvement in quality and patient safety at Doylestown
The rapport developed between Aetna and Doylestown Hospital
has led to discussions about additional patient safety initiatives
and options for alternative reimbursement approaches with incentives
for the hospital and its Medical Staff.