U-M Has Saved Medicare Money While Improving Treatment Of Heart And Diabetes Patients, Report Shows

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Diabetes;  Cardiovascular / Cardiology
Article Date: 15 Aug 2008 - 1:00 PDT

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Older patients with heart disease and diabetes are getting better treatment than ever at the University of Michigan Health System -- even while U-M's care for Medicare patients is costing less, a new report shows. The data come from the second year of a national project undertaken by 10 large physician groups, including the U-M Faculty Group Practice.

The results were announced in Washington, D.C., by the Centers for Medicare and Medicaid Services. CMS oversees the Medicare system and launched the project to encourage innovation, efficiency and the development of quality improvement efforts that might be used by doctors and hospitals nationwide.

U-M was one of only two participating groups that achieved both of the project's aims: to provide the highest-quality care on all 27 of the project's heart and diabetes measures, and to contain health care spending growth for all traditional Medicare patients, including those with costly chronic illnesses.

As a result, U-M will get to keep $1.24 million of the funding that Medicare would have otherwise spent on the care of U-M patients in that year, and will also earn more than $460,000 as an incentive for providing high-quality care.

This is the second year in a row that U-M has achieved both sizable savings and high scores on health care quality benchmarks as part of the project, even as the project was expanded to include patients with heart failure and coronary artery disease. Two more years worth of data remain to be collected and analyzed.

The U-M Faculty Group Practice, part of the U-M Medical School, includes all 1,500 U-M faculty physicians who care for patients at the three U-M hospitals and 40 U-M health centers. Many of the programs and innovations that U-M has put in place for this project involve not only physicians but nurses, social workers, care managers and others who are involved in the care of Medicare patients at all U-M facilities.

The report is based on data from approximately 20,000 Medicare participants who received nearly all their care at U-M during the year that began April 1, 2006. It does not include those who were enrolled in a Medicare Advantage plan offered by a private health plan, nor Medicare participants who received only limited care at U-M. But the improvements made for the project are helping many other patients.

"The U-M Faculty Group Practice funded this project because we thought it was the right way to care for our patients," says David Spahlinger, M.D., senior associate dean for clinical affairs. "We felt confident we could improve quality but we were uncertain if our interventions would save money. I believe that this project will provide many lessons for policy makers as the nation confronts the rising costs of health care."

The project's formal name is the Medicare Physician Group Practice Demonstration. It is Medicare's first Pay for Performance Demonstration Project to work directly with physician groups. It began by focusing on the quality of care of patients with diabetes, but in the second year was expanded to include heart failure and coronary artery disease - both chronic heart conditions that carry a very high risk of emergency hospitalization, and other care, if not managed appropriately.

Because of its participation in this project, U-M is also automatically participating in another Medicare project, the Physician Quality Reporting Initiative or PQRI. In fact, the $460,000 that U-M earned for achieving high-quality care on 27 benchmarks is being paid through PQRI. The dollars U-M earned for saving Medicare money are calculated using a separate formula.

U-M's success in both years of the project can be largely attributed to efforts to redesign the way patients are cared for, to enhance coordination and efficiency and reduce the need for emergency care and repeat hospital stays.

Project leader Caroline Blaum, M.D. - associate professor of internal medicine, associate chief of geriatric medicine and a research scientist at the VA Ann Arbor Healthcare System - notes that many faculty and staff from the Faculty Group Practice and Hospitals & Health Centers worked together to make the changes possible. Both entities are under the larger umbrella of the U-M Health System, which makes collaboration easier.

"The innovative thinking and willingness to do what's right for patients regardless of the prospect of direct reimbursement has truly been exceptional," she says. "And ultimately, we have been able to show that innovations can pay off in both improved care for patients and savings for Medicare."

In the first year of the project, U-M implemented a number of new tactics to help improve care for Medicare patients, most of which are still in place today. In the second year, that effort was expanded and a number of new programs made their debut. Among them:

Sub-acute Care Service: This program brings U-M physicians and nurse practitioners specializing in geriatric care directly into certain nursing homes in the Ann Arbor, Ypsilanti, Canton and Plymouth, Mich., areas. The clinicians help patients discharged from U-M hospitals to these nursing homes, and their work has already decreased the number of days patients spend in the hospital.

CHOICES (Creating Healthcare Options to Inpatient Care and Emergency Services): This effort provides a nurse practitioner and social worker who can travel to a patient's home soon after he or she goes home from the hospital, to help with issues such as diabetes management. This program is available to a large number of U-M patients who need specialized in-home care soon after being discharged from the hospital, to help them until they can see their regular doctor.

Expanded Inpatient Geriatrics Consult Service: This service makes it easier for U-M geriatricians, who specialize in the care of older adults, to assist other U-M physicians in assessing and managing the needs of older hospitalized patients - no matter what their main reason for being in the hospital.

Emergency Medicine Consult/Referral Service: Designed for any patient seen at the U-M Emergency Department who needs follow-up care of any kind, this program helps ensure that they get appointments at U-M clinics. The program's staff members make telephone contact with patients soon after they return home, and coordinate their scheduling while also alerting their primary care physician and processing insurance authorizations.

U-M's Faculty Group Practice is the only organization in Michigan taking part in the project. It was chosen for several reasons, including demonstrated success in chronic care management, diabetes quality and organizational structure. For more information on the project, visit http://www.cms.hhs.gov/DemoProjectsEvalRpt. Click on "Medicare Demonstrations" and then search for "Medicare Physician Group Practice Demonstration."

University of Michigan Health System
http://www.med.umich.edu