More providers meeting CMS performance benchmarks
Healthcare providers looking for signs of encouragement about the success of accountable care organizations received a few last week when the CMS released results from its fiveyear Physician Group Practice Demonstration.
That demonstration—which began in 2005 and ended last year—is seen as a precursor to the ACO model outlined in last year’s Patient Protection and Affordable Care Act. Of the 10 physician practice groups that participated, seven achieved benchmarks for all 32 quality measures in the fifth and the final year of the demonstration. The other three, meanwhile, hit the target for at least 30 of the measures.
All 10 groups met benchmark performance on heart failure, coronary artery and preventive-care measures, according to the CMS, which reported that four groups—Marshfield (Wis.) Clinic; Park Nicollet Health Services in St. Louis Park, Minn.; St. John’s Health System in Springfield, Mo; and the University of Michigan Faculty Practice Group in Ann Arbor—will share $29.4 million out of the total $36.2 million in savings to the Medicare program.
Marshfield Clinic earned about $15.8 million of the shared savings—the highest share among the four groups. It achieved the benchmarks for every quality measure except one that involves documenting care for patients who have high blood pressure. The clinic has since implemented an electronic system to remind physicians to document that area, said Marilyn Follen, the administrator of the clinic’s Institute of Quality, Innovation and Patient Safety.
“Two things contributed to our success in year five,” said Mark Skubic, vice president of government relations at Park Nicollet, which earned an incentive payment (about $5.7 million) for the first time in the demonstration’s final year. “First, a more robust focus on the chronically ill. Second, because of that, the greatest change we saw in our data was we had significant decreases in hospital readmissions.”
All 10 of the demonstration participants are now participating in the CMS’ transition demonstration, a two-year supplement to the original program that began Jan. 1. The transition demonstration emphasizes the role of primary-care providers in care coordination.
“ CMS in the transition will give us monthly claims data feeds so we can track our patients a little more closely,” Skubic said. In addition, the CMS will compare the expenditure growth rate against a national average in the transition demonstration, as opposed to a regional comparison that was used in the initial project.
Providers including Park Nicollet and Marshfield Clinic are keeping their options open as they await a final rule on accountable care organizations from the CMS. In the meantime, Skubic said providers should stay the course.
“Focus on improving the system, not declaring it dead or alive,” Skubic said of the coordinated-care delivery model. “One of the things we’ve learned is how to improve the model—as opposed to giving up.”