PAY-FOR-PERFORMANCE
The Bottom-Line – all payors will require providers to demonstrate quality in order to get paid.
- In 2007, the Centers for Medicare and Medicaid Services (CMS) initiated P4P with its Medicare Physician Quality Reporting Initiative (PQRI). Under PQRI, participants are eligible to receive an incentive bonus of 1.5 percent of total allowable CMS fee schedule charges, if they report the requisite claims data on 80 percent of patients.
- A recent report on State Medicaid programs indicates over 50% currently operate and within 3 years over 85% will add P4P programs.
- Another study concludes P4P programs are evolving critical component to all commercial insurance programs
MindLinc is designed specifically for this purpose – to prove and improve quality of care.
MindLinc delivers and supports the world’s most comprehensive, customer-configurable behavioral health care management system. MindLinc’s Decision Support Engine provides customers with the ability to guide and enforce clinical, regulatory, and pay-for-performance/payor rules. Our customers express their appreciation for how easy the system is to implement, configure to match their users’ workflow and use.
MindLinc’s Decision Support Engineprovides customers with the ability to guide and enforce clinical, regulatory, and pay-for-performance / payor rules.
- Establish and enforce internally developed clinical practices and guidelines
- Capture necessary data to meet Pay for Performance requirements
- Ensure collection of all data required for billing
- Collect all Joint Commission required data
- Embed behavioral health specific clinical practice guidelines
- Monitor Suicidal Risk Factors (continuously monitors high risk factors)
- Implement Evidence Based Practices
The Decision Support Engine can prompt and alert clinicians to perform specific activities based on the preferred workflow - as a task at the start of their documentation process, as a prompt during their charting, or as a reminder prior to signing their note. In simple terms the Decision Support Engine can set rules, "if the patient has x condition (or complex conditions of u,v,w and x) then do y."
Case Example:
Using the decision support rules engine in Duke’s behavioral health EMR, CRIS, (Clinical Research Information System) customers are guided through the CMS quality P4P measures for Major Depressive Disorder. Duke Behavioral Health Informatics also provides rule sets to comply with the CMS PQRI P4P measures for Screening for Future Fall Risk, Medication Reconciliation, and Advance Care Plans
For more information on the CMS PQRI P4P initiative please go to the CMS website at