All ten physician groups participating in the CMS Physician Group Practice (PGP) Demonstration improved the quality of care for patients and earned $1.67 million. The groups made a difference in the quality of care treating CHF, coronary artery diseases, and diabetes mellitus during the second performance year of the demonstration. The PGP demonstration is one of CMS’ value-based purchasing (VBP) initiatives and connects Medicare payments to performance on healthcare cost and quality measures.
All ten participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers. Five of the groups, Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John’s Health System, and the University of Michigan Faculty Group Practice achieved benchmark quality performance on all 27 quality measures.
The Physician Quality Reporting Initiative (PQRI) a related CMS VBP effort uses a pay-for-reporting approach. Under the PQRI, physicians and other healthcare professionals can earn incentive payments for reporting measurement data about the quality of care that they provide to Medicare patients.
CMS is developing a Physician VBP Plan to move from the PQRI pay-for-reporting approach to a performance-based approach for Medicare physician payments. The experience that CMS has gained from the PGP Demonstration will be considered in developing the performance-based payment plan.
Also in August, CMS awarded contracts for the 9th Statement of Work for the 53 contractors participating in Medicare’s Quality Improvement Organization (QIO) Program. The contracts extend from August 1, 2008 through July 31, 2011. The new contracts also provide additional tools for CMS and the QIOs themselves to track, monitor, and report on the impact that QIOs have on the healthcare provided in their states and jurisdictions.
The 9th SOW will initiate some changes such as working on projects that span the entire spectrum, focus on quality improvement resources where they are needed the most, develop a more robust monitoring framework, and address disparities issues across the continuum of care.