MPP Performance Evaluation, Improvement and Remediation Policy | October 2021 | Newsflash

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October 7, 2021

MPP Performance Evaluation, Improvement and Remediation Policy

 

McLaren Physician Partners (MPP) is a CIN (Clinically Integrated Network) and is legally required by the Department of Justice (DOJ) and Federal Trade Commission (FTC) to monitor and evaluate the ongoing clinical performance for CIN participating physicians and to provide support, counsel, and accountability for participating physicians whose performance is not meeting CIN standards. On at least a quarterly basis, MPP will analyze reports regarding the performance of all participating CIN physicians against the measures and initiatives established for the Clinical Integration (CI) Program.            

The MPP Quality and CI Sub-Committee has developed the following sub-optimal performance criteria:

  • A Quality Metric Scorecard (QMS) score of zero points with no individual HEDIS measures above the 50th percentile.

With respect to individual participating physicians who fail to meet the standards established for the CI Program, a summary of the remediation process is as follows:

  1. After two (2) consecutive quarters where the physician fails substantially to meet the performance standards of the CI Program, the participating physician will be required to meet with a MPP Regional Medical Director (RMD).
  1. As a result of that meeting, the participating physician and the RMD will develop an improvement plan.  Included in this plan will be recommended action steps, availability of resources and a timeline for improvement. Generally, the timeline for improvement will have a duration of between sixty (60) to ninety (90) days.
  2. At the end of the designated timeline for improvement if a participating physician has completed the necessary improvement steps, no further action will be recommended. However, if the participating physician fails to show significant improvement, the participating physician may be recommended for immediate probation. A physician placed on probation will not be eligible for a MPP Clinical Integration Distribution.
  3. In response to the probation, the following steps will take place:
    1. A second (2nd) improvement plan will be developed and will require the signature of the participating physician.
    2. The MPP Board of Directors will be notified of the plan for improvement.
    3. The participating physician shall remain on probationary status for a duration of six (6) months.
    4. At the end of the probation period, a review of the progress of the action plan will determine if a recommendation that the participating physician be released from probation or be recommended for removal from the CIN.

For more information, please contact Dr. Michael Ziccardi, at michael.ziccardi@mclaren.org or (248) 484-4923