Only a few physician groups participating in a care-coordination demonstration project are meeting the programs targets, according to a Government Accountability Office report.
In 2000, the CMS was ordered to test various payment methodologies that combined Medicare fee-for-service payments with new incentive payments. The demonstration, begun in April 2005, offered annual bonus payments to 10 participating physician groups, provided they met targets on cost savings and quality.
In the first performance year, all 10 implemented care-coordination programs focused on patients the participants believed would most likely generate cost savings, such as those with congestive heart failure. However, only two of the 10 participants earned a bonus payment during the first year for achieving cost savings and meeting quality-of-care targets.
The CMS design for the demonstration project created challenges for the participants, the report noted. As an example, neither bonuses nor performance feedback for the first performance year were given to participants until after the third year had begun. GAO recommended that the CMS should offer participating physician groups interim reports that estimate their progress in the demonstration.
In addition, broadening the payment approach used in the demonstration to other physician groups and non-group practices may be challenging, since the 10 groups currently participating are larger than the average physician group in the United States, the GAO cautioned. -- by Jennifer Lubell
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