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Team Play in Medicine Nets Medicare Quality, Savings Gains

By John Reichard, CQ HealthBeat Editor

August 14, 2008 -- In what federal officials call their first test of paying doctors based on the quality and efficiency of their care, Medicare's "Physician Group Practice" demonstration Thursday reported gains in quality and in some cases lowered costs under the revised payment incentives.

The findings "have profound implications for shaping health care reform in America," Don Fisher, president of the American Medical Group Association, said in an afternoon telephone press briefing.

All 10 of the physician groups in the test improved the quality of care to patients with congestive heart failure, coronary artery disease, and diabetes in the second year of the four-year demonstration project, the Centers for Medicare and Medicaid Services (CMS) reported. Four of the 10 groups lowered the costs of care to patients at the same time they improved the quality of treatment.

The four groups are the Dartmouth-Hitchcock Clinic in New Hampshire, the Everett Clinic in Washington, the Marshfield Clinic in Wisconsin, and the University of Michigan Faculty Group Practice.

The 10 groups earned $16.7 million in incentive payments as a result of their performance.

The four "earned $13.8 million in performance payments for improving the quality and cost efficiency of care as their share of a total of $17.4 million" in Medicare savings they generated, CMS said in a news release.

The results show that "by working in collaboration with the physician groups on new and innovative ways to reimburse for high-quality care, we are on the right track to find a better way to pay physicians," said acting CMS administrator Kerry Weems.

Participants emphasized their use of teams including different types of doctors to provide the right care at the right time to chronically ill patients. Barbara Walters, senior medical director of the Dartmouth-Hitchcock Clinic, said her health system treats some of the most medically complicated cases in its area but still generated savings. Walters said the key is using multidisciplinary teams of doctors who coordinate services working off a common electronic health record for patients.

Nurses at the clinic work with high-risk patients using motivational educational programs on disease and personal health care. Regular calls to patients to assure they are getting needed care and to check on their medical conditions are part of the mix. "The patients adore this service," she said. "They like to get calls from the doctor's office just checking on them."

Other techniques used in the demo include having a "visit planner" prepare a "to-do" list for doctors prior to each patient's visit. Doctors get a one-page summary for each patient with key clinical and demographic data, including test dates and results and reminders for needed tests or treatments.

At the Everett Clinic, hospital patients and their caregivers are coached to guide them through complicated care processes in the hospital and when they are discharged.

The Medicare Payment Advisory Commission and other analysts have emphasized the importance of rewarding doctors for quality and efficiency and of encouraging hospitals and doctors to coordinate on more efficient, higher-quality care as a way to improve the value of Medicare spending.

But in many instances providers do not coordinate the way they do in the medical groups in the demo.

Ted Praxel, a physician at the Marshfield Clinic, said "the clinic's success today really hasn't come easily."

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