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Newsletter Article


Getting the Most from Medicare

Participants in Medicare's Physician Group Practice (PGP) Demonstration are charged with improving the coordination of care for their fee-for-service beneficiaries, investing in administrative and process improvements to increase efficiency, and improving the quality of patient care. If the practices accomplish these goals and slow health spending growth, they will share in the financial benefits of their efforts.

According to a Commonwealth Fund report prepared by RTI International, the 10 PGP sites, which include more than 5,000 physicians treating upwards of 200,000 Medicare beneficiaries, have used the demonstration to expand data systems, care management programs, coordination-of-care efforts, and other interventions that are not directly reimbursed by Medicare. The focus among participating group practices, the authors say, has been "less on direct financial rewards for individual providers and more on 'getting the reimbursement system out of the way' so that doctors can provide services they know that patients need." The demonstration is currently in the second of three scheduled years, and is projected to run through March 2008.

Another Fund report, Enhancing Value in Medicare: Demonstrations and Other Initiatives to Improve the Program, illuminates the process for identifying, testing, evaluating, and implementing Medicare policy improvements focused on chronic care management and provider performance. The Fund's Stuart Guterman and Michelle Serber say that more resources and a clearer, more flexible process are needed to help Medicare target the right areas for improvement, implement the most promising interventions, and evaluate their results.

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