CMS pays $16.7M to groups in P4P demo, but few get big bucks

You've gotta love it when CMS gives out money above and beyond the usual reimbursement rates--and it's even better when the bonuses work out for pretty much everyone involved. That's the cheery story being told about the results of the second year of CMS's pay-for-performance demonstration project, under which 10 physician groups earned a total of $16.7 million in incentive payments. The thing is, only a few groups actually received quality bonuses, despite significant improvements, leaving them to share much smaller quality data reporting incentives.

Under the terms of the demonstration project, which addresses the quality of care for heart patients and diabetics, physician groups were asked not only to improve outcomes for Medicare patients, but also to coordinate their care. The groups involved were strikingly successful at meeting CMS's goals. All of the groups involved in the Physician Group Practice Demonstration met performance goals on at least 25 of 27 quality markers for patients with diabetes, coronary artery disease and congestive heart failure. Five of the groups, including Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John's Health System and the University of Michigan Faculty Group Practice--achieved all 27 performance goals.

However, groups involved didn't necessarily get much of a financial reward. In fact, while all shared in the $2.9 million pot for the Physician Quality Reporting Initiative, when it came to the more substantial bonuses, only four groups got a large payment. Dartmouth-Hitchcock Clinic, Everett Clinic, Marshfield Clinic and University of Michigan Faculty Group Practice divided up the $13.8 million of the payout related specifically to P4P, despite the fact that the other six met quality targets. Groups like the Billings Clinic didn't get a share of the $13.8 million because they didn't meet financial performance criteria, participants said. These groups are suggesting that CMS should change their criteria in future iterations of its P4P programs.

To learn more about the P4P payouts:
- read this Modern Healthcare piece (reg. req.) or this Modern Healthcare piece (reg. req.)

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