All 10 of the physician groups participating in the Centers for Medicare and Medicaid Services' Physician Group Practice (PGP) Demonstration achieved benchmark performance on at least 28 of the 32 measures reported in the third year of the pilot demonstration. As a result of their efforts to reduce the growth rate in Medicare expenditures, five of those physician groups are receiving performance payments totaling $25.3 million as part of their share of $32.3 million of savings generated for the Medicare Trust Funds for the year.
Over the first three years of the demonstration, the physician groups increased their quality scores an average of 10 percentage points on 10 diabetes measures, 11 points on 10 congestive heart failure measures, 6 points on seven coronary artery disease measures, 10 points on two cancer screening measures, and 1 percentage point on three hypertension measures.
Two of the groups—Geisinger Clinic, headquartered in Danville, PA, and Park Nicollet Health Services, headquartered in St. Louis Park, MN—achieved benchmark performance on all 32 performance measures.
The demonstration seeks to encourage coordination of Medicare Part A and Part B services, promote efficiency through investment and administrative structure and processes, and include electronic medical records and chronic disease management strategies, said Donald Fisher, PhD, president and CEO of the American Medical Group Association, in Alexandria, VA, which sponsored a teleconference yesterday with representatives of the 10 medical groups.
"The results of this demonstration clearly show that these types of organizations—which can be referred to as accountable care organizations—can significantly improve the cost and quality of care in America," Fisher said. "Better quality is less costly, and this demonstration definitely demonstrates that ACOs are a viable model, and any healthcare reform proposal should address reimbursement policy such that it promotes these types of organizations."
Fred Bloom, MD, assistant chief quality officer with Geisinger, said in the teleconference that Geisinger has focused on hard wiring reminders and alerts into the patients' electronic health records to "enhance the consistency and reliability"—particularly related to diabetes and coronary care.
"By participating in this project, we've been able to develop more efficient ways of consistently bringing quality and value to all of our patients by developing these systems of care that apply to everyone—and not just the Medicare beneficiaries, who are the focus of the demo project," he said. "We've show through this project that it is possible to improve quality and reduce costs in healthcare—which is very important for the current healthcare reform [movement]."
David Wessner, Park Nicollet Health Services' president and CEO, said that with its work on a chronic hear failure program operated during the CMS demonstration, they were able to save $6 for every invested dollar in the program.
"This is the type...of new patterns of care that is exciting but it is also what has to be accomplished if we're going to see true reform," Wessner said. "We have been able to pursue new patterns of care that really would be impossible to take on if it were not for the economic structure of this demonstration project."
Marshfield (WI) Clinic's President Karl Ulrich attributed its success in the demonstration to the use of electronic health records developed internally at the clinic. "We use the data warehouse that provides point-of-care decision-making by our physicians and other providers when they are seeing patients—whether that would be in the hospital, in the clinic or at home (in evening) while they are on call," he said.
"It's this decision support—looking at the situation such as drug-drug interactions or allergies that patients have . . . [making] sure we're doing all the appropriate tests on a person that allow for point-of-care decision support that we think is critical," Ulrich said. "That drives the quality outcomes here."