CMS proposes small-practice P4P pilot

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The Centers for Medicare & Medicaid Services (CMS) is seeking public comment on a proposed three-year, pay-for-performance (P4P) pilot project that would reward four solo, small- or medium-size physician practices that use IT to help care for Medicare beneficiaries with congestive heart failure, coronary heart disease and diabetes.

The agency would target practices treating at least 50 Medicare beneficiaries in Arkansas, California, Massachusetts and Utah for its Medicare Care Management Performance (MCMP) demonstration.

Goals of the pilot include:

  • Improving the continuity of care;
  • Helping to stabilize chronic conditions;
  • Preventing chronic conditions from worsening; and
  • Reducing negative health outcomes.

Mathematica Policy Research of Princeton, N.J., is evaluating the MCMP program using a congressionally mandated test of incentives to encourage physicians to improve the quality of care they provide to seniors and disabled beneficiaries with chronic conditions.

Doctors who meet or exceed performance standards established by CMS receive bonus payments for managing the care of eligible Medicare beneficiaries. In its first year, the demonstration is a "pay-for-reporting" initiative to help physicians become familiar with the quality measurement process.

Mathematica's evaluation, funded by CMS, is assessing implementation; impacts on quality of care, continuity of care, Medicare costs, and beneficiary and physician satisfaction; and the extent to which the effects of financial incentives depend on beneficiary and physician-practice characteristics.

The evaluation involves case studies of 100 physician practices, surveys of nearly 5,000 Medicare beneficiaries and 1,600 physicians in both demonstration and comparison groups, and analysis of Medicare claims data and clinical measures.