CMS Pay-for-Performance Pilot Has Improved Quality Of Care, Lowered Costs

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 18 Aug 2008 - 0:00 PDT

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CMS on Thursday reported that a pilot program paying physicians based on quality and efficiency of care has shown gains in quality of care and in some cases lowered costs, CQ HealthBeat reports. In the second year of the four-year "Physician Group Practice" demonstration, all 10 groups participating improved quality of care to patients with congestive heart failure, coronary artery disease and diabetes, CMS reported. Four of the groups also reduced the cost of care to patients and reduced CMS spending by $17.4 million.

Physicians participating in the project said the success could be attributed to their use of teams that include different types of doctors to provide the right amount of care at the right time to chronically ill patients. Barbara Walters, senior medical director of the Dartmouth-Hitchcock Medical Center, said her health system saw some of the most medically complicated cases in its geographic area but still was able to achieve savings. She added that electronic health records played a critical role in allowing the multidisciplinary team to coordinate services. Other participants said they used a "visit planner" to create "to-do" lists for physicians prior to each patient's visit. The lists included a one-page summary that showed key clinical and demographic data, test dates and results, and reminders for needed tests and treatments for individual patients (Reichard, CQ HealthBeat, 8/14).

In all, participating physicians received $16.7 million in incentive payments. According to a CMS release, the four groups that lowered costs "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 they generated. Acting CMS Administrator Kerry Weems said the results indicate 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" (CMS release, 8/14).

The Medicare Payment Advisory Commission and other analysts have said it is important to reward doctors for quality and efficiency and to encourage hospitals and physicians to coordinate on more high-quality, efficient care as a strategy to improve the value of Medicare spending. American Medical Group Association President Don Fisher in a telephone press briefing said the results "have profound implications for shaping health care reform in America" (CQ HealthBeat, 8/14).

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