Centers for Medicare & Medicaid Services (CMS)
Physician Group Practice (PGP)
Demonstration
The first ‘value-based purchasing’
demonstration applied to providers.
Theodore A. Praxel, MD, MMM, FACP
Medical Director – Quality Improvement and
Care Management
June 29, 2009
Marshfield Clinic
Formed 1916
Multi-specialty group
Physician led – 501C3
~780 physicians
43+ sites
~400,000 unique pts/yr
~3.5M encounters/yr
Health Plan
Research Foundation
Education Division
Reference Laboratory
Centers for Medicare and Medicaid Services Physician Group
Demonstration Project
Goals – Improve efficiency (decrease costs) while improving
quality (measured on 32 quality metrics) for assigned vs.
comparison group of Medicare beneficiaries in the same
geographic location getting care from non-site providers.
● Improve coordination b/t Part A & Part B expenditures
● Align reimbursement with quality (32 quality measures)
● Reward for improving health outcomes
Marshfield Clinic selected as 1 of 10 participating sites
nationally
All are groups of > 200 physicians
Long term commitment –
● Application 2003
● Baseline data 2004
● Originally 3 years starting 4/1 annually
● Extended to 5 years (currently in 5th year)
Process & Outcome Measures
Hypertension & Cancer
Screening
Diabetes Mellitus
(PY1,2,3,4,5)
Congestive Heart Failure
(PY 2,3,4,5)
Coronary Artery Disease
(PY 2,3, 4,5)
HbA1c Management
LVEF Assessment
Antiplatelet Therapy
Blood Pressure Screening
HbA1c Control
LVEF Testing
Drug Therapy for Lowering LDL
Cholesterol
Blood Pressure Control
Blood Pressure Management
Weight Measurement
Blood Pressure
Blood Pressure Plan of Care
Lipid Measurement
Blood Pressure Screening
Lipid Profile
Breast Cancer Screening
LDL Cholesterol Level
Patient Education
LDL Cholesterol Level
Colorectal Cancer Screening
Urine Protein Testing
Beta-Blocker Therapy
Ace Inhibitor Therapy
Eye Exam
Ace Inhibitor Therapy
Foot Exam
Warfarin Therapy
Influenza Vaccination
Influenza Vaccination
Pneumonia Vaccination
Pneumonia Vaccination
(PY 3, 4, 5)
Why enter the CMS PGP Project?
Consistent with the Clinic’s mission
Marshfield Clinic’s long term strategy built
around the six aims of the Institute of Medicine.
Marshfield Clinic was headed in the direction of
value based health care which is consistent with
the CMS PGP demonstration project.
ALL interventions for the CMS PGP demo are
applied to ALL Marshfield Clinic patients.
How did we intervene for the PGP project?
Multiple simultaneous interventions
Best practice models developed for core conditions
Computer based Continuing Medical Education opportunities
Care management programs
● 24/7/365 Nurse line
● Anticoagulation Service
● Telephonic Heart Failure Care Management
Population based feedback to providers
Health Information Technology – Chartless 2007
Physician/Clinical Nurse Specialist regional teams
Chartless environment - 2007
Marshfield Clinic Results
Performance year one (4/05 – 3/06)
● Exceeded 9 of 10 quality measures (improved all from
baseline year)
● Performance payment of $4,565,327
● Total Savings to CMS of $12,062,878
Performance year two (4/06 -3/07)
● Exceeded 27 of 27 quality metrics
● Performance payment of $5,781,573
● Total Savings to CMS of $13,124,683
Performance year three (4/07 -3/08)
● Results anticipated Summer 2009