The Centers for Medicare & Medicaid Services have announced that Dartmouth-Hitchcock Clinic, along with nine other physician groups participating in an innovative, Centers for Medicare and Medicaid Services (CMS)-sponsored Physician Group Practice (PGP) Demonstration, improved performance on the delivery of preventive care, and care for patients with chronic illness while generating millions of dollars in savings for the Medicare program through quality improvement and better coordination of care.
The PGP demonstration provides incentives for better coordination of Medicare Part A and Part B services, promotes the investment in care management programs and redesigned care processes, and rewards physicians for improving health outcomes. Under the demonstration, physician groups are held accountable for the quality of care and the growth in Medicare expenditures for the patient population they serve. In turn, the physician groups have the flexibility to redesign care to improve quality and reduce Medicare expenditure growth.
Over the first three years of the demonstration, the physician groups have increased their quality scores an average of 10 percentage points on the diabetes measures, 11 percentage points on the congestive heart failure measures, 6 percentage points on the coronary artery disease measures, 10 percentage points on the cancer screening measures, and 1 percentage point on the hypertension measures. All of the physician groups achieved benchmark performance on at least 28 of the 32 measures reported in Performance Year Three.
As a result of the improved efficiency, Dartmouth-Hitchcock, along with four other 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 Performance Year Three.
"At Dartmouth-Hitchcock, this initiative fits right into the organization's mission and its vision to achieve the healthiest population possible," said Barbara Walters, M.D., Dartmouth-Hitchcock's Senior Medical Director. "The program has challenged us to find ways to innovate in the way we deliver care to all of our patients by taking a systems approach to improving the efficiency and the quality of our care. Another key to the program's success was in allowing us the flexibility to develop systems that worked best for us, and not trying to impose a one-size-fits-all methodology."
Performance Year Three was the first year that all 32 measures were in effect for the demonstration. The measures focus on diabetes, congestive heart failure, coronary artery disease, hypertension, and cancer screening. The measures are consistent with clinical practice and high quality care and have support from the physician community. Given the acceptability of the measures and the reporting methodology, CMS recently announced that other large physician groups may use this reporting methodology and similar measures to participate in the Physician Quality Reporting Initiative starting in 2010.
Physician groups have focused on redesigning care to improve quality and reign in Medicare expenditure growth. Their efforts have included better coordinating care for patients transitioning between care settings, proactively reaching out to patients with chronic illness and more aggressively monitoring them between physician visits, and identifying patients early so that end of life care may be better coordinated.
Health information technology plays a critical role by providing practitioners in the group with more complete clinical information about the patient that can be used to monitor patients between visits, identify gaps in care, and better coordinate services.
Dartmouth-Hitchcock was featured on the CBS Evening News in early July for its performance as part of this demonstration project.