PGP Demonstration

CBO Report Questions Success of Medicare Demonstration Projects

A new report (Lessons from Medicare's Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment) by the Congressional Budget Office paints a depressing picture of the cost effectiveness of many Medicare demonstration programs.  This report reviewed the outcomes of 10 major demonstrations conducted by CMS and concludes that few of them have any effect on cost and quality.  The summary of the report presents its major findings:

Comments on the PGP Demonstration from former CMS Administrator

An interesting article in the New England Journal of Medicine by former CMS administrator Gail Wilensky describes some of the complications that participating providers encountered in the Physician Group Practice demonstration project.  These included lack of data provided in a timely manner, which impeded the ability of the participants to effectively manage their populations.  The article relates the results of this demonstration project to the structure proposed by CMS for accoun

CMS Physician Group Practice Demonstration Results

The results of the Physician Group Practice (PGP) demonstration project have recently been released and are available from CMS here. Of interest in these results is the unevenness of the results. Of the 10 participating groups, one group received 52% of all shared savings payments, while three groups failed to achieve any shared savings.

Risk Scoring and the Luck of the Draw

Many recent healthcare initiatives, including the Accountable Care Organizations that are created under health reform, utilize risk adjusters to compensate for the differences in disease status of the members.  These risk adjusters are used to establish payment targets that compare costs incurred by patients in the organization to what the costs “should be” based on those patients’ diagnoses.  The accuracy of the risk adjusters, therefore, is critically important when significant amounts of money are involved.  A small percentage difference between the risk-

Syndicate content