Highmark to expedite bonus money to bolster physicians
Highmark Inc. is moving to bolster primary care doctors dealing with financial issues caused by COVID-19 by paying its quality of care bonuses two months early.
Checks totaling $32 million for more than 1,700 primary care practices that treat Highmark members in Pennsylvania, West Virginia and Delaware were being sent out the week of April 6 instead of in June, Highmark Inc. President Deborah Rice-Johnson said.
Three hundred medical practices in Pennsylvania will be getting the advance money. The bonuses are set up as a reward for meeting quality of care metrics in treating people with Highmark health insurance.
With offices closed or otherwise taking steps to stop the spread of the novel coronavirus, typical revenue streams have been disrupted. “They’re not seeing patients in their offices unless it’s absolutely necessary,” Ms. RiceJohnson said about the doctors. “They’re all feeling the financial impact.”
Participating doctors and medical practices receive the bonus money on a quarterly basis, but June is the biggest payout of the year.
Highmark’s performance initiative rewards doctors up to 30% of the insurer reimbursement for following treatment protocols and administering timely vaccinations and preventive health screenings that can prevent more serious problems. The criteria, which are tweaked annually, include such things as blood sugar monitoring for people with
diabetes and regular colon and breast cancer screening.
The insurer estimates the quality metrics have helped avoid $1.5 billion in health care costs.
The announcement comes as the Centers for Medicare and Medicaid Services is advancing payments to doctors and hospitals up to three months early because of the financial squeeze caused by preparing for and treating people with COVID-19, a highly contagious respiratory disease.
Most providers can request up to 100% of the Medicare payment amount, with some hospitals eligible for advance payments up to 125%.
Albert Wright, president and CEO of WVU Medicine in Morgantown, said Tuesday that some hospitals in West Virginia had seen volume decreases ranging between 35% and 50%, cutting deeply into the institution’s bottom line.
Highmark’s quality of care bonus program, which was developed years ago, is among the biggest in the country, Ms. Rice-Johnson said. “Valuebased models are the way of the future.”