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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.”

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