Physicians in large group practices have successfully made quality and cost-efficiency improvements in their care after completing the first year of a three-year demonstration project sponsored by the Centers for Medicare & Medicaid Services. A new Commonwealth Fund report details the ways more than 5,000 physicians have expanded care and interventions to Medicare beneficiaries through performance payments rather than direct fee-for-service reimbursements. CMS’ Physician Group Practice Demonstration, begun in April 2005, offers financial rewards for better-than-expected performance to 10 large groups with no penalties assessed for underperformance.
The improvements made by the group practices were clustered in four broad areas. Most of the groups developed disease management programs for diabetes and heart-failure patients because of the prevalence of these diseases in the Medicare population and for their potential to reduce costs and improve quality. Specific improvements included better hospital and emergency-room discharge planning to prevent readmissions and to ensure appropriate follow-up care. Physicians also modified their practice patterns and work processes to obtain more comprehensive feedback on patients and to take a more global approach to managing a panel of patients. In addition, terminal patients received expanded palliative and hospice care. And practices enhanced their information technology capabilities to track high-risk patients, provide detailed reports on patients, and to automate physician reminders on specific patients’ needed care.
