This fact sheet from the Centers for Medicare and Medicaid Services (CMS) reports the results from the fourth year of the Medicare Physician Group Practice Demonstration. The demonstration program was the first pay-for-performance demonstration in the Medicare fee-for-service program and is an important foundation for the proposed Medicare Shared Savings Program accountable care organizations involving physicians and hospitals.

After the fourth year of the five-year demonstration, all ten of the participating physician groups (consisting of over 5,000 physicians providing health care service to over 220,000 Medicare fee-for-service beneficiaries) achieved quality improvement targets (on at least 29 of 32 measures related to diabetes, congestive heart failure, coronary artery disease and preventive care).  This continues the improvements in quality achieved and maintained since the first year of the demonstration.

However, only five of the ten physician groups earned incentive payments based on estimated savings in Medicare expenditures.  These five groups received a total of $31.7 million, or nearly 82%, of the $38.7 million savings that CMS estimated was saved through the demonstration in year four.  These five physician groups are the same five physician groups which earned incentive payments totaling $25.3 million (78% of the $32.3 million in savings CMS estimated) in year three.  A sixth physician group did earn an incentive payment after year two but has not earned any incentives in years three or four.  Four of the ten physician groups have yet to receive any incentive payments after four years.

The fact sheet also describes some of the quality improvement activities implemented by the ten physician groups during the demonstration, including:

  • Patient registries
  • Increased use of electronic health records
  • Dashboard reports to providers
  • Increased use of evidence-based guidelines and decision support
  • Reports for patients
  • Medication reconciliation
  • Increased use of nurses on care team and as care managers
  • Developing individual care plans
  • Motivational education
  • Coaching at hospital discharge and at other transition of care
  • Care coordination
  • Disease and case management
  • Patient self-management
  • Computerized telephonic monitoring
  • Home-based monitoring
  • Early/proactive physician follow up after discharge
  • Community-based crisis intervention services
  • Palliative care

However, since each of the ten participating physician groups has chosen a different set of these interventions, it is not clear which have been or will be the most effective (and in what combinations) in achieving the quality improvements and cost reductions.

Link to Original Source

The results reported in the fact sheet are summarized and discussed, including implications for designing Medicare Shared Savings Program ACOs, in this open access article from the New England Journal of Medicine.

Link to Original Source

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