Physicians, Hospitals and Health Systems

Physicians, Hospitals and Health Systems


Health insurance reform also means Medicare and Medicaid payment reform.

We can help you prepare for that change.

Most physicians today—particularly specialists—are facing reduced fee schedules. PROMETHEUS Payment relieves this pressure by tying bonus opportunities to reductions in potentially avoidable complications (PACs). You will continue to get paid under your current negotiated fee schedule. Then, if you manage patients well and minimize PACs, you can potentially earn bonus payments as well.

Hospitals and health systems are facing pressures of their own – namely, the need to reduce readmissions, reduce patient safety failures, and greatly improve the value of services provided. The PROMETHEUS Payment model can help you prepare for this change by converting PAC reductions into margins that can fund quality improvement activities.

A substantial PAC allowance is included in each budget. If complications occur, this allowance is used to offset costs of corrective treatment. But if you reduce or eliminate PACs, you keep the entire allowance as a bonus. PROMETHEUS includes additional incentives to reward provider performance on clinical process, outcomes of care, and patient experience.

The program uses medical records, claims data, and other data to measure the quality of care delivered to patients. In doing so, it provides access to a wealth of sophisticated information, which you can use to compare your performance to established industry baselines and work step by step to improve it.