WASHINGTON – All 10 physician practices participating in the Medicare Physician Group Practice Demonstration improved the clinical management of diabetes patients in the first year of the three-year Centers for Medicare and Medicaid Services project, according to CMS.
Yet only two of those practices generated enough savings through quality and efficiency improvements to earn performance bonus payments. And they used information technology to help them do it.
The Marshfield Clinic of Marshfield, Wis., and the University of Michigan Faculty Group Practice in Ann Arbor, Mich., together provided more than $9.5 million in savings to the CMS trust fund. Marshfield provided savings of $6.03 million and the U-M FGP saved Medicare $3.5 million over the course of the project’s first year, which ran from April 1, 2005 to March 31, 2006.
“We proved that you don’t have to reduce the quality of care to cut Medicare costs,” said Caroline Blaum, MD, a geriatrician who leads the Michigan PGP project. “We actually added services at no cost to patients or payers.”
The U-M FGP created a diabetes quality program that relied on the University of Michigan Health System’s electronic medical record to provide physician feedback on the quality of care for patients with diabetes. U-M physicians can access patient information at the point of care, making them immediately aware of a quality problem and encouraging quick action to resolve it.
The Marshfield Clinic previously garnered national attention for its internally developed EMR, called Cattails MD, which was the first in-house system to gain certification from the Certification Commission for Healthcare Information Technology.
Marshfield executives said they leaned heavily on their homegrown EHR and other IT tools to hit nine of the 10 PGP diabetes quality measures.
“Information technology is very helpful in dealing with our care management protocols,” said Theodore Praxel, MD, Marshfield’s medical director of quality improvement and care management. “We’ve got 2,000 tablets and 400 wireless points in 41 clinic locations. We can capture the necessary information up front and then return it to providers in as close to real-time as possible.”
The Marshfield IT staff created an intervention list – called “iList” – that ranks patients hierarchically according to who meets, or does not meet, quality metrics. The timely data – which is only 48 hours old – helps providers determine which patients need what kind of care.
Praxel said Marshfield intends to invest a large majority of the bonus payment into additional quality improvement tools such as iList.
Marshfield’s performance payment from CMS will be approximately $4.5 million, while the University of Michigan Health System will receive $2.7 million from Medicare.
While only two PGP practices will receive bonus payments based on the first year results, many observers expect all participants will create significant returns for Medicare, so long as IT plays a significant role in data collection.
“All ten of the CMS sites are moving toward patient registries and electronic data reporting,” said Jeremy Meller, CIO of the clinic division at Marshfield. “The current results simply show that different sites are at different points in the evolution of their strategies. The important thing is to have an IT roadmap that emphasizes quality. This project should encourage people that investment in IT shows a real return.”
