Medicare's pay-for-performance experiments
The Centers for Medicare & Medicaid (CMS) recently announced the results of three of its latest pay-for-performance demonstration projects – one for large physician practices, one for solo and small physician practices and one for hospitals. In all three settings, offering financial incentives for meeting or exceeding performance standards improved quality of care and saved Medicare money, according to CMS.
In the first three years of the Physician Group Practice (PGP) demonstration, the 10 large practices involved in the project increased their quality scores an average of 10 percentage points on diabetes measures, 11 points on congestive heart failure measures, six points on coronary artery disease measures, 10 points on cancer screening measures and one point on hypertension measures. All of the practices reached benchmark performance on at least 28 of the 32 measures.
In the first year of the three-year Medicare Care Management Performance (MCMP) demonstration, more than 560 of the 610 small and solo physician practices in the demonstration will be rewarded for their performance on 26 quality measures. The average incentive payment per practice is $14,000 (out of a possible bonus of $50,000 per practice), although some practices will receive as much as $62,500 if they qualify for an additional 25 percent bonus for using an electronic health record (EHR) certified by the Certification Commission for Health Information Technology.
The Hospital Quality Incentive Demonstration (HQID) began in 2003 with hospitals in 38 states. Participating hospitals raised their overall quality scores by an average of 17 percentage points over four years. This number is based on 30 nationally standardized measures for heart attack, coronary by pass graft, heart failure, pneumonia, and hip and knee replacements. For year four of this demonstration, CMS is awarding a total of $12 million to 225 hospitals for their achievements and has shelled out more than $36.6 million during the course of this demonstration alone.
Words of caution
Mathematica Policy Research, Inc., has been contracted to independently evaluate the MCMP project for CMS. In their first report, issued March 4, 2009, the researchers noted that although demonstration practices reported greater awareness of care or documentation gaps, "At the same time, the data submission effort was labor-intensive, according to many visited practices; five had calculated that the cost of their effort was greater than the incentive payment they received for reporting the quality measures. Several were unsure if they would submit data in the coming year, because they were uncertain whether the potential reward was worth the effort. Half of these tentative practices consisted of solo practitioners. Many practices with EHRs felt frustration as their EHRs did not facilitate submission very well, due to system limitations, variations in use within the practice, or both." Mathematica's final report is due in 2011.
Posted at 12:28PM Aug 31, 2009
by Lynn Hofeldt |