Newswise — Participants improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus, generated at least $17.4 million in savings for the Medicare program, and earned $16.7 million in incentive payments.
On August 14, Centers for Medicare & Medicaid Services (CMS) announced second-year results of the Medicare Physician Group Practice (PGP) Demonstration and the American Medical Group Association (AMGA) hosted a teleconference featuring medical groups that are participating in the demonstration. CMS announced that all 10 participating physician groups improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus during performance year 2 of the demonstration. As a result, the 10 groups earned $16.7 million in incentive payments under the demonstration, which rewards healthcare providers for improving health outcomes and coordinating the overall healthcare needs of Medicare patients assigned to the groups.
Of the 10 participating physician groups, 8 are AMGA members: Billings Clinic; The Everett Clinic, Dartmouth-Hitchcock Clinic; Forsyth Medical Group; Geisinger Clinic; Marshfield Clinic; Park Nicollet Health Services; and St. John's Health System (Middlesex Health System and University of Michigan Faculty Group Practice are the other participants).
All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease, and congestive heart failure.
Five of the physician groups"•Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John's Health System, and the University of Michigan Faculty Group Practice"•achieved benchmark quality performance on all 27 quality measures.
James Lee, MD, assistant medical director at The Everett Clinic, estimated the total savings for the Medicare program during the first two years of the demonstration to be $55 million. "The results from the second year of the demonstration have profound implications for shaping healthcare reform in America and only add to the growing body of evidence in support of coordinated care," commented AMGA President and Chief Executive Officer Donald W. Fisher, Ph.D., CAE. "As the voice of medical groups in America, AMGA has been a champion of coordinated care, and these results demonstrate, once again, the efficiencies and quality that can be found in multispecialty medical groups and other organized systems of care."
"We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollar," said Kerry Weems, acting administrator of CMS. "And these results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high-quality care, we are on the right track to find a better way to pay physicians."
As participant groups shared their strategies for success in the demonstration, certain common themes emerged. A prominent theme was the excellence of care coordination common to all multispecialty medical groups and other organized systems of care and how this coordination contributed to the outcomes achieved. A variety of other factors also contributed to the success of groups in the demonstration. The groups attributed improved patient outcomes and reductions in hospitalizations to collaboration and commitment of staff to a common goal, improved transitional care processes at the time of hospital discharge, and disease management prompts during face-to-face encounters. Providing the "right care at the right time" was a common theme among all participant groups. Electronic health records were repeatedly cited as being an essential element in the coordination of care, and were described as the "glue" that holds the system together by Dr. Lee, of The Everett Clinic.
BackgroundThis demonstration is one of CMS' value-based purchasing (VBP) initiatives. The goal of VBP is to tie Medicare payments to performance on health care cost and quality measures. VBP is part of CMS' drive to transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care.
A related CMS physician VBP effort is the Physician Quality Reporting Initiative (PQRI), which uses a pay-for-reporting approach. Under the PQRI, physicians and other health care professionals can earn incentive payments for reporting measurement data about the quality of care they provide to Medicare patients
CMS is also starting development of a Physician VBP Plan for moving from the PQRI pay-for-reporting approach to a performance-based approach for Medicare physician payments. The experience that CMS has gained from the PGP Demonstration will be considered in developing the performance-based payment plan.
The 10 physician groups participating in the PGP Demonstration agreed to place their PQRI incentive payments at risk for performance on the 27 quality measures reported under the demonstration. All physician groups received at least 96 percent of their PQRI incentive payments, with five groups earning 100 percent of their incentive payments. A total of $2.9 million in PQRI incentive payments was paid out to the 10 groups under the demonstration.
The groups also improved the quality of care delivered to Medicare beneficiaries on the chronic conditions measured. Physician groups increased their quality scores an average of 9 percentage points across the diabetes mellitus measures, 11 percentage points across the heart failure measures, and 5 percentage points across the coronary artery disease measures.
These groups achieved outstanding levels of performance by having clinical champions (physicians or nurses who are in charge of quality reporting for the practice) at the practice, redesigning clinical care processes, and investing in health information technology. The enhancements to their electronic health records and patient registries allow practices to more easily identify gaps in care, alert physicians to these gaps during patient visits, and provide interim feedback on performance.
In addition to achieving benchmark performance for quality, several physician groups also experienced favorable financial performance under the demonstration's performance payment methodology. For patients with diabetes or coronary artery disease, Medicare expenditures grew more slowly for beneficiaries assigned to the physician groups than for beneficiaries in the comparison group with the same conditions.
This lower expenditure growth for chronic conditions as well as complex patients treated in the ambulatory and hospital settings contributed to four physician groups sharing in savings for improving the overall efficiency of care they furnish their patients.
According to CMS, the four physician groups"•Dartmouth-Hitchcock Clinic, The Everett Clinic, Marshfield Clinic, and the University of Michigan Faculty Group Practice"•earned $13.8 million in performance payments for improving the quality and cost efficiency of care as their share of a total of $17.4 million in Medicare savings. This compares to two physician groups that earned $7.3 million in performance payments under the first year of the demonstration.
The results are for the second performance year of the demonstration which covered April 1, 2006 through March 31, 2007. The initial three-year demonstration was extended for a fourth performance year, which runs through March 2009.
About the American Medical Group Association The American Medical Group Association (AMGA) advocates for multispecialty medical groups and other organized systems of care and for the patients served by these systems by continuously striving to improve patient care through innovation, information sharing, benchmarking, the creation of sound public policy, and leadership development. AMGA's vision is to make multispecialty medical groups and other organized systems of care the preferred delivery system for coordinated, patient-centered, efficient, quality medical care in America. Members of AMGA partner with an organization comprised of the best and brightest in health care, the most innovative leaders from the premier integrated systems dedicated to delivering the highest quality care to their patients. The medical group members of AMGA deliver health care to more than 80 million patients in the United States and play active roles in raising the standard of care in their communities and nationwide. AMGA members are on the vanguard of treatment and disease management and offer coordinated care that enhances the quality of life for their patient populations and advances health care and medical science. AMGA is a conduit to information, networking, education, and operational tools and a champion for medical groups in the national arena. For more information, visit http://www.amga.org.
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