Marshfield Clinic Saves Medicare Millions While Improving Quality Of Care

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice;  Public Health
Article Date: 20 Aug 2009 - 0:00 PDT

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Marshfield Clinic has improved the quality of health care it delivers to patients while decreasing health care costs in the third performance year of a five-year Medicare demonstration project, the Centers for Medicare & Medicaid Services (CMS) announced today.

"Marshfield Clinic saw years ago that reform was necessary," said Theodore A. Praxel, M.D., M.M.M., FACP, medical director, Quality Improvement and Care Management, Marshfield Clinic. "This project accelerated our own reform efforts - aggressive, innovative changes - and that work is showing results. Marshfield Clinic has done great work three years in a row and this year exceeded quality measures, earning 52 of 53 quality points. This is also further evidence that Marshfield Clinic is not satisfied with today, but looks forward to innovation and change that will increase value for our patients in the future."

Marshfield Clinic is one of only two out of a total of 10 large physician group practices to achieve this honor each of three years. Because of this success, Marshfield Clinic has so far saved the Medicare program more than $48 million over the three performance years reported.

"Health care cost and payment for delivering quality care are issues at the center of the nation's health care reform debate now, so Marshfield Clinic is especially pleased to demonstrate for a third year that we provided savings for Medicare while further improving quality of care for the patients we serve," Praxel said.

Medicare beneficiaries receiving the plurality of their care in the Clinic system experienced improved quality of care at a lower cost to the federal Medicare program, compared to Medicare beneficiaries getting their care in the same geographic region from other providers.

CMS, part of the U.S. Department of Health and Human Services, initiated this Physician Group Practice (PGP) Demonstration to allow physician group practices to prove that providing proactive, coordinated care can also save money.

"Participation in this project teaches us ways to more quickly advance the value of care we deliver to all Marshfield Clinic patients," Praxel said. "Our goal is to help them receive the right care at the right time at the right place."

While the 10 participating group practices showed lower growth in Medicare expenditures collectively, Marshfield Clinic was one of five to generate significant savings under the terms of the demonstration that resulted in a performance payment. Those sites, besides Marshfield, that received payments are University of Michigan Faculty Group Practice, Ann Arbor, Michigan; Dartmouth-Hitchcock Clinic, Bedford, New Hampshire; Geisinger Clinic, Danville, Pennsylvania; and St. John's Health System, Springfield, Missouri.

"The performance payment Marshfield Clinic receives will allow us to continue beneficial health care activities that are not reimbursed by Medicare right now," Praxel said. The Clinic is receiving a bonus payment of about $13.8 million which will be used to fund further quality improvement initiatives.

An independent third party determined that Marshfield Clinic did better in controlling growth in Medicare spending than its comparison group - other health care providers located in the same geographic region as Marshfield Clinic - by providing services in a more cost-effective manner resulting in savings to Medicare while at the same time improving quality outcomes.

"While our patients were receiving quality care prior to the project, our participation has further enhanced that quality and demonstrated our cost effectiveness," said Marilyn A. Follen, R.N., M.S.N., administrator, Quality Improvement and Care Management. "Most important, changes made through this project benefit all Marshfield Clinic patients, not just our assigned Medicare beneficiaries.

"The efforts of our physicians and staff during the third performance year allowed Marshfield Clinic to improve the efficiency of care delivery and to exceed more than 98 percent of the quality measures set by CMS," Follen added. "This resulted in more than $23 million in savings to CMS in the third year. These results speak well for the dedication and hard work of all Clinic physicians and staff members."

"Marshfield Clinic is committed to improving the value we deliver to our patients. Participating in this demonstration project proves we can reduce costs yet provide high quality health care," said Karl Ulrich, M.D., M.M.M., Marshfield Clinic president and chief executive officer. "We're achieving these results because our physicians and staff work as a cohesive team to benefit all our patients. Our entire organization is committed to doing difficult work which results in true health care reform and we are not done with this process."

Marshfield Clinic has made substantial investments to develop needed tools to improve quality of care delivered to patients, even prior to this project. For example:

• a well-developed electronic health record (EHR) and is a leader in information technology. All Clinic physicians have access to patient records from all Clinic centers through the EHR, which helps to eliminate duplication of services, like lab tests and imaging. The EHR helps plan visits; addresses care at the time of the visit; and assures appropriate monitoring of chronic conditions is performed.
  
  
• a well-established telemedicine initiative
  
  
• a 24-7 telephone nurse line for advice and triage
  
  
• anticoagulation clinic
  
  
• congestive heart failure clinic
  
  
• cholesterol management programs

"Marshfield Clinic's sophisticated EHR was needed for success, but it would not have been enough without efforts of physicians and staff to integrate the EHR into patient care," Praxel said. "The EHR helps make care more efficient since all results, notes and studies completed at Marshfield Clinic sites are available throughout the Clinic system. This helps decrease repeat testing and improve coordination of care between caregivers, no matter where in the Clinic system patients are located.

"We are pleased to have been successful at efficiently using resources for our patients' benefit and while we are delighted with these results, we will continue to work to improve," Praxel said.

CMS Demonstration Project results being reported measure Year 3 - April 1, 2007, to March 31, 2008. The project, extended a fifth year, concludes March 31, 2011. Marshfield Clinic has about 37,000 people assigned by CMS, the largest group of beneficiaries in the project, with an overall total of about 225,000 participants.

Year 1 - 10 measures for quality outcomes were reported to CMS and two sites. Marshfield Clinic and University of Michigan Faculty Group Practice generated adequate savings to CMS to earn a performance payment for improving quality and efficiency of care.

Year 2 - 27 measures were reported. Marshfield Clinic, Dartmouth-Hitchcock Clinic, The Everett Clinic and the University of Michigan Faculty Group Practice earned a performance payment.

Year 3 - 32 measures were reported for diabetes, congestive heart failure, coronary artery disease, hypertension and cancer screening. All 10 sites met at least 28 of the 32 quality measures. Sites (listed above) received a performance payment.

Source:

Teresa Derfus
Marshfield Clinic