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Medicare News
Medicare Declares Major Success in Project Treating
Costly Chronic Disease
University of Michigan saved CMS $3.5 million and
improved care
July 12, 2007 – One out of four senior citizens in
Medicare suffers with five or more chronic conditions and they account
for 68 percent of Medicare spending. Medicare declared yesterday that
all participating physician groups participating in a demonstration
project aimed at better managing the health care of those with these
chronic conditions have improved the clinical management of diabetes
patients in the first year of the three-year Medicare Physician Group
Practice (PGP) Demonstration. Diabetes is a major chronic disease among
seniors.
Under the demonstration, which began April 1, 2005,
physician groups continue to be paid on a fee-for-service basis and have
the opportunity to share in savings generated from enhancements in care
management, says the Centers for Medicare & Medicaid Services.
A total of 223,893 Medicare patients were assigned
to the ten physician groups in performance year 1 which ended March
2006.
All ten of the participating physician groups -
Billings Clinic, Everett Clinic, Dartmouth-Hitchcock Clinic, Forsyth
Medical Group, Geisinger Clinic, Middlesex Health System, Marshfield
Clinic, Park Nicollet Health Services, St. John’s Health System, and the
University of Michigan Faculty Group Practice - achieved benchmark or
target performance on at least seven of the ten diabetes clinical
quality measures. Two physician groups -- Forsyth Medical Group and St.
John’s Health System – met all ten benchmarks.
One of the unique features of this demonstration is
that physician groups have the flexibility to redesign care processes
for patients with chronic illness and complex health care needs, as well
as invest in care management initiatives.
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“Twenty-three percent of beneficiaries have five or more of
the chronic conditions that account for 68 percent of Medicare
spending. They see an average of 11 physicians and fill 50
prescriptions a year. Creating payment incentives that can lead
to better patient outcomes and lower total costs is the right
thing to do,” CMS Acting Administrator Leslie V. Norwalk
said. |
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This helps Medicare beneficiaries maintain their
health and avoid further illness and admissions to the hospital at no
additional cost and with no reductions in benefits. If these efforts
save money for the Medicare program, the physician groups are able to
share in a portion of those savings.
As a result, in addition to the quality
improvements across all groups, two groups – Marshfield Clinic and
University of Michigan Faculty Group Practice – earned performance
payments for quality and efficiency of $7.3 million as their share of
the $9.5 million in savings to the Medicare program.
University of Michigan Saves Medicare $3.5 Million
The University of Michigan Faculty Group Practice
reports saving Medicare $3.5 million, while being able to significantly
improve both the quality and efficiency of care that Medicare
beneficiaries received at its hospitals and health centers.
The U-M Faculty Group Practice, which includes all
the physicians on the U-M Medical School faculty who treat patients at
U-M facilities, achieved 95 percent of its targets for providing
specific, proven treatments and preventive measures to people with
diabetes.
In addition, UMHS improved care for its Medicare
patients with many other types of chronic diseases, especially those who
may have more than one disease, by redesigning care to enhance
coordination and efficiency. Working together, the FGP and the U-M
Hospitals and Health Centers developed and implemented programs that not
only contributed to better care, but also saved Medicare money.
“Defining the best way to practice medicine for our
patients is advancing from theory to a proven reality, as this project
demonstrates. Now we have a year of data from CMS to show that doing the
right thing for our patients is win-win. I’m looking forward to more
validation in coming years for redesigning patient care processes to
improve clinical quality,” says David Spahlinger, M.D., FGP executive
medical director.
The PGP Medicare Demonstration project provided an
opportunity to share in the savings resulting from more efficient and
effective care delivery. As a result, UMHS saved Medicare $3.5 million
in savings the first performance year, from April 1, 2005 to March 31,
2006, largely from inpatient Medicare expenditures. Under a CMS formula,
UMHS will be able to keep $2.7 million of these savings.
“We proved that you don’t have to reduce the
quality of care to cut Medicare costs. We actually added services at no
cost to patients or payers,” says Caroline Blaum, M.D., the U-M
geriatrician who is leading the project. “For our many Medicare patients
with diabetes, we have scientific, evidence-based quality indicators
that demonstrate the high quality of care provided by the U-M FGP.”
Several programs were redesigned, enhanced, or
created for the first year of the project including:
● Diabetes Quality Program: This program
uses the UMHS electronic medical record system to provide individual
physician/provider feedback on the quality of care for their patients
with diabetes, often at the point of service. This allows the physician
and patient to quickly see where there is a quality problem and correct
it.
● Transitional Care Call-back Program:
Nurses, dubbed by some as ‘care traffic controllers,’ call patients and
caregivers within 24 hours of a patient’s discharge from the emergency
department and hospital, helping them to understand post-discharge
instructions and to solve problems such as keeping the next appointment,
understanding medications, getting a test or procedure, or finding
transportation.
● Chronic care coordination: Social
workers and nurses work with physicians to assist patients who have
multiple risks, multiple chronic diseases, and complex health status.
● Pharmacy-facilitated discharge: A
clinical pharmacist visits patients before discharge from the hospital
to coordinate hospital medications with the medications the patient was
taking before hospitalization, and to teach about medications and their
benefits and side-effects.
● Heart failure telemanagement program:
Nurses work closely with patients and cardiologists to teach patients to
manage their heart failure by modifying life-style and adhering to
complex medical regimens.
Other initiatives have been launched since that
first year concluded, and their impact will be seen in the data from
subsequent years that will be released in future, the Michigan group
reports.
While patients with chronic conditions benefited
from UMHS’s redesigned care coordination, only data from beneficiaries
with diabetes was used in the calculation of quality. In the coming
years, heart failure, coronary artery disease, hypertension and
preventative services quality measures will be added.
A total of 20,505 Medicare beneficiaries who
receive most of their health care at the UMHS were “assigned” to U-M as
part of the PGP demonstration project during the first performance year.
Approximately 20 percent of those patients have
diabetes. Because U-M is a tertiary referral center, nearly 20,000 other
Medicare patients were seen only for referral and were not considered
part of the Medicare Demonstration Project.
The UMHS Faculty Group Practice is one of ten
participants in the PGP Demonstration Project, and the only one in
Michigan. It was chosen for several reasons including demonstrated
success in chronic care management, diabetes quality, and organizational
structure.
The Faculty Group Practice is the unit within the
Medical School through which the faculty provide clinical services to
patients within the University of Michigan Health System. There are more
than 1,200 physicians within the Faculty Group Practice. The Medicare
Demonstration Project will last until March 31, 2008, but may be
extended.
Editor’s Notes:
Mary Beth Reilly contributed to this report from
the University of Michigan
For more information on Medicare Payment
Demonstrations sponsored by the Centers for Medicare & Medicaid
Services, go to
www.cms.hhs.gov/DemoProjectsEvalRpts.
University of Michigan Health System
Centers for Medicare & Medicaid Services
U-M Faculty Group Practice
U-M Medical School
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