The Medicare Physician Group Payment Demonstration—which ended after five years in March 2010, though final results were just released—has been closely followed as an early attempt to wrench payment away from fees based on sheer volume.
The demonstration is also considered the precursor to accountable care, a model already being tested in the private market ahead a planned Medicare launch in 2012.
Here's an overview of the demonstration's results:
Quality performance improved. Doctors earned bonuses based on quality performance and savings under the demonstration and accountable care. The 10 medical groups met benchmarks for 30 out of 32 quality measures for diabetes, congestive heart failure, heart attack and preventive care in the final year.
Nonetheless, no more than five of 10 groups earned bonuses in any given year. Only the Marshfield Clinic in Wisconsin and University of Michigan were paid bonuses every year.
The Marshfield Clinic took home $15.8 million for the fifth year, more than the combined bonuses for three other medical groups to earn incentives. For the five years, Marshfield's bonuses totaled $56.2 million, or 55% of the total $102.9 million awarded during the entire five years.
Why did some earn bonuses and others none?
The CMS considered the question in a 2009 report to Congress. The report, which used data from the first two years, speculated on possible reasons, but did not reach any conclusions. Researchers lacked evidence that linked efforts to better manage disease or care to lower costs, stating “evidence of their impact is largely anecdotal.”
The CMS has not updated its 2009 analysis, an agency spokeswoman said.
Dr. Theodore Praxel, Marshfield Clinic's medical director of quality improvement and care management, said an early jump on information technology (computer punch cards held the clinic's first version of electronic records more than 24 years ago) contributed to the Wisconsin medical group's success. So did the decision to put primary-care doctors first in line as the clinic quickened its deployment of hand-held computers, said Marilyn Follen, the Marshfield Clinic Institute of Quality, Innovation and Patient Safety administrator.
The clinic's performance also benefited from intervention efforts for congestive heart failure and blood thinner patients that were expanded or accelerated during the Medicare demonstration, said Praxel. But he stressed that no one effort could be cited as the reason the clinic consistently earned bonuses.
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