• CMS Announces Results from HQID, PGP and MCMP Demonstration Projects
  • December 14, 2010 | Author: Kerrie S. Howze
  • Law Firm: King & Spalding LLP - Atlanta Office
  • According to the Centers for Medicare and Medicaid Services (CMS), results from three key demonstration projects provide support for the contention that offering financial incentives to providers to improve patient care increases the quality of care and can reduce growth in Medicare expenditures.  The results, released in a December 9, 2010 press release (the Press Release), are from the Hospital Quality Incentive Demonstration (HQID), the Physician Group Practice (PGP) Demonstration and the Medicare Care Management Performance (MCMP) Demonstration.

    The Hospital Quality Incentive Demonstration
    The HQID is a demonstration program sponsored by Medicare in partnership with Premier Healthcare Alliance designed to test whether paying hospitals for performance based on quality measures associated with certain clinical conditions would improve the quality of inpatient care.  CMS announced that $12 million in incentive payments is being awarded to 212 hospitals.  The 212 hospitals are receiving the incentive payments for top performance, top improvements and overall attainment in six clinical areas: heart attack, coronary bypass graft, heart failure, pneumonia, hip and knee replacements, and the Surgical Care Improvement Project (SCIP).  CMS has awarded more than $48 million through the first five years of the HQID. 

    The Physician Group Practice Demonstration
    The PGP Demonstration creates incentives for physician groups to coordinate the overall care delivered to Medicare patients, rewards physician groups for improving the quality and cost efficiency of health care services, and creates a framework for collaboration with providers.  Physician groups earn incentive payments based on both the quality of care they provide as well as the estimated savings they generate in Medicare expenditures.

    During the fourth year of the demonstration, all 10 participating physician groups achieved benchmark performance in 29 of the 32 measures, and three out of those 10 physician groups achieved benchmark performance on all 32 measures, according to CMS.  Each of the 10 physician groups achieved benchmark performance on the 10 heart failure measures and seven coronary artery measures.  Over the first four years of the PGP Demonstration, the physician groups increased their quality scores an average of 10 percent on 10 diabetes measures, 13 percent on seven heart failure measures, 6 percent on seven coronary artery disease measures, 9 percent on two cancer screening measures and 3 percent on three hypertension measures.

    CMS announced that five physician groups will receive $31.7 million in payments as part of their share of $38.7 million in savings generated for the Medicare Trust Fund in performance year for of the PGP Demonstration.         

    The Medicare Care Management Performance Demonstration
    The MCMP Demonstration aims to promote the use of health information technology to improve the quality of care for beneficiaries with chronic conditions.  Physicians practicing in small to medium-sized practices in California, Arkansas, Massachusetts and Utah who meet clinical performance standards on specified measures are eligible to receive financial rewards, and can receive an additional bonus for reporting data using an electronic health record certified by the Certification Commission for Health Information Technology.

    CMS is awarding approximately $9.5 million in incentive payments to more than 500 small and solo physician practices in the participating states for providing high quality preventive care and care for chronically ill patients.  CMS reported that the average payment per practice is $18,100, although some practices earned as much as $62,500.