Wednesday, September 2, 2009

CMS Reports on Demos

The Nursing Home Value-Based Purchasing Demonstration offers financial incentives to nursing homes that meet certain conditions for providing high quality care. The demonstration is open to free-standing and hospital-based facilities with financial rewards going to those facilities that improve or deliver quality care, achieve good outcomes, and avoid unnecessary hospitalizations.

CMS will conduct the demonstration in 79 nursing homes in New York, 62 in Wisconsin and 41 in Arizona. Each of these states assisted in the recruitment process by encouraging facilities to apply to CMS. The demonstration will run from July 2009 through June 2012.

The Physician Hospital Collaboration Demonstration that began July 2009 is evaluating whether gainsharing leads to improvements in quality and efficiency. The demonstration provides an opportunity for hospitals and physicians to join forces to improve quality, efficiency, improve the use of inpatient resources, and to achieve cost reductions.

The demonstration is administered by the New Jersey Hospital Association and has twelve hospitals participating. The program tracks patients beyond a hospital episode to determine the impact of hospital-physician collaborations on preventing short and longer term complications and to determine whether services are duplicated.

The Medical Hospital Gainsharing Demonstration began in October 2008. This demonstration is currently at two sites, Beth Israel Medical Center in New York City, and Charleston Area Medical Center in West Virginia. Under this demonstration, CMS will evaluate whether gainsharing leads to short-term improvements in quality and efficiency during the inpatient stay and immediately following discharge.

According to CMS, the Hospital Quality Incentive Demonstration (HQID) entering its fifth year shows continued quality improvement among participating hospitals. The HQID is sponsored by Medicare in partnership with Premier, Inc., a national hospital quality measurement organization. The demonstration which began in 2003 with hospitals in 38 states was designed to test payment incentives under Medicare to see if they would improve the safety, quality and efficiency of inpatient services by linking incentives to improved quality.

Participants raised overall quality by an average of one percentage point over four years, based on their performance on more than 30 nationally standardized and widely accepted care measures for patients in five clinical areas such as heart attack, coronary bypass graft, heart failure, pneumonia, and hip and knee replacements.

CMS is awarding incentive payments totaling $12 million in year four to 225 hospitals for top performance, top improvements and overall attainment in the five clinical areas. Through the first four years, CMS awarded more than $36.6 million to top performers. After the initial three years of the demonstration, CMS extended the project for three additional years to test new incentive models and ways to improve patient care.

Physician practices participating in the Physician Group Practice (PGP) Demonstration continue to improve quality for patients with chronic illnesses or requiring preventive care. All ten of the physician groups participating in the demonstration achieved benchmark performance on at least 28 of the 32 measures reported in year three of the demonstration. Two groups Geisinger Clinic in Danville PA and Park Nicollet Health Services in St. Louis Park, MN achieved benchmark performance on all 32 performance measures.

Under the PGP demonstration, physician groups earn incentive payments based on the quality of care they provide and the estimated savings they generate in Medicare expenditures for the patient population they serve. As a result of their efforts, five physician groups will receive performance payments totaling $25.3 million as part of their share of $32.3 million of savings generated for the Medicare Trust Funds in year three.

Over the first three years, the physician groups increased their quality scores an average of 10 percentage points on ten diabetes measures, 11 points on ten congestive heart failure measures, 6 points on seven coronary artery disease measures, 10 points on two cancer screening measures, and one percentage point on three hypertension measures.

More than 560 small and solo physician practices participating in the Medicare Care Management Performance (MCMP) Demonstration have been rewarded for providing high quality care in the delivery of preventive care and care for patients with chronic illnesses. The goal of the demonstration is to promote the use of health information technology to help beneficiaries with chronic conditions.

Doctors in small to medium sized practices who meet clinical performance standards on each measure are eligible to receive financial rewards under the MCMP demonstration. The demonstration also provides an additional bonus to practices that report the data using an EHR certified by CCHIT. Twenty three percent of practices were able to submit at least some of the measures from a certified EHR.

In the first year of the MCMP demonstration, almost all of the 610 participating small and solo physician practices were rewarded for performance on 26 quality measures. CMS is awarding $7.5 million in incentive payments to over 560 practices in California, Arkansas, Massachusetts, and Utah. The average payment per practice is $14,000 but some practices earned as much as $62,500. Last year, CMS paid out over $1.5 million for incentives for reporting baseline quality measures.

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