• E-mail
• Print
• RSS

Medicare begins performance-based reimbursement for physicians

Quality Improvement Monitor, February 3, 2005

CMS on January 31 announced new initiatives to pay healthcare providers for the quality of the care they provide to seniors and people with a disability, moving pay for performance into the physician practice setting.

"Better care should be rewarded, and thanks to growing support from healthcare providers and other stakeholders, we have better approaches to doing so than ever before," said CMS Administrator Mark B. McClellan, MD, PhD. "It is time that we pay for the quality of the healthcare provided to our beneficiaries, not simply the amount. We are working to apply this in every setting in which Medicare and Medicaid pays for care."

During the three-year project, CMS will reward 10 physician groups in various communities across the nation that improve patient outcomes by coordinating care for chronically ill and high-cost beneficiaries in an efficient manner.  The physician groups participating in the demonstration are: Dartmouth-Hitchcock Clinic in Bedford, NH; Deaconess Billings Clinic in Billings, MT; The Everett (WA) Clinic; Geisinger Health System in Danville, PA; Middlesex Health System in Middletown, CT; Marshfield (WI) Clinic; Forsyth Medical Group in Winston-Salem, NC; Park Nicollet Health Services in St. Louis Park, MN; St. John's Health System in Springfield, MO; and the University of Michigan Faculty Group Practice in Ann Arbor, MI.

Under the demonstration, physician groups will continue to be paid on a fee-for-service basis. The groups will implement care-management strategies designed to anticipate patient needs, prevent chronic disease complications and avoidable hospitalizations, and improve quality of care. Depending on how well these strategies work in improving quality and avoiding costly complications, physician groups will be eligible for performance payments.

Medicare currently reimburses physicians and other health care providers on the number and complexity of the services provided to patients. 

• E-mail to a Colleague
• Print
• RSS
• Archive