Healthcare Business News

CMS: 7 of 10 doc groups in demonstration now meet performance benchmarks

By Jessica Zigmond
Posted: August 8, 2011 - 2:45 pm ET

Seven of the 10 physician groups that participated in the CMS' Physician Group Practice Demonstration achieved benchmarks on all 32 performance measures in the fifth year of the project, the CMS reported Monday.

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The agency also announced that all 10 of the groups are now participating in the PGP Transition Demonstration, a two-year supplement to the original demonstration program. The PGP demonstration, which started in April 2005, was organized as a way to identify ways to improve care across different settings while lowering costs. Policymakers relied on earlier findings from the demonstration to shape the accountable care organization model that is laid out in the Patient Protection and Affordable Care Act, according to the CMS.

The Billings (Mont.) Clinic; Everett (Wash.) Clinic; Forsyth Medical Group, Winston-Salem, N.C.; Geisinger Health System, Danville, Pa.; Middlesex Health System, Middletown, Conn.; Park Nicollet Health Services, St. Louis Park, Minn.; and St. John's Health System, Springfield, Mo. achieved the program's 32 performance measures after the fifth year of the demonstration. The other three groups—Dartmouth-Hitchcock, Bedford, N.H.; Marshfield (Wisc.) Clinic; and University of Michigan Faculty Group Practice in Ann Arbor—met 30 of those measures. As a comparison, just two physician groups achieved benchmark performance on all of the measures after the first year, according to the CMS. All 10 of the groups achieved benchmark performance on heart-failure, coronary-artery and preventive-care measures.

Meanwhile, four of the groups will receive incentive payments of $29.4 million out of the total $36.2 million in savings to the Medicare program. A CMS representative was not available at deadline to identify which groups will receive those payments.

The transition demonstration seeks to gather additional performance data from providers as the Medicare Shared Savings Program and the Pioneer Accountable Care Organization become operational, the CMS noted. To realize shared savings in the new program, physician groups will need to have lower growth in Medicare costs relative to a national benchmark, and the assignment algorithm will be based on services provided by primary-care physicians rather than by physicians of all specialties.

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