St. John’s Saves Medicare $17.6 Million During Five-Year Project.
Medicare patients are getting better care at Sisters of Mercy Health System (Mercy) locations in southwest Missouri and northwest Arkansas, and staff have saved $17.6 million on the cost of that care over five years.
Mercy’s savings come from five years of participation in Medicare Physician Group Practice (PGP) Demonstration Project. It is Medicare’s first Pay-for-Performance Demonstration Project to work directly with physician groups like the Mercy’s St. John’s Clinic. St. John’s monitored more than 30,000 patients with chronic conditions cared for by any of the nearly 500 integrated physicians treating patients at six Mercy hospitals and more than 70 Mercy St. John’s physician clinic offices in Mercy’s north Central region.
The practices in the PGP Demonstration are also recognized as prototypes for Accountable Care Organizations. The project demonstrates the benefits of Accountable Care Organizations, an initiative now written into the nation’s health care reform law.
All 10 participating physician groups have signed agreements for participation in the PGP Transition Demonstration (PGP TD). The PGP TD is a two-year project similar to the original project. At the end of the PGP TD, the PGP groups will be given the opportunity to transition to a Medicare Shared Savings Accountable Care Organization Program or an initiative in the Center for Medicare and Medicaid Innovation
Numbers for the fifth and final year were released recently. In the fifth year, St. John’s achieved 100% performance on all of the 32 quality measures. In addition, St. John’s saved more than $3.3 million by reducing costs to Medicare through quality improvement strategies and redesigning care.
Medical director for the project Dr. Jim Rogers, an internist in Springfield, Mo., said lessons learned included:
It's better to stay healthy than it is to treat an illness. Preventive care is less expensive care. Mercy devised a registry to track patient care and identify any gaps related to the 32 quality measures that CMS specifies for conditions such as diabetes, coronary artery disease and congestive heart failure, and preventive activities such as high blood pressure and colon and breast cancer screenings.
“I hear physicians say ‘I’m really taking better care of my patients now,’” Dr. Rogers said. “It all comes down to priorities and time. The tools we’ve developed help us to be a little more organized and focused on prevention. It’s also helped our patient see that good care is a collaborative effort that they participate in.”
Coordinated and Well-Managed Care improves quality
Care redesign involved a wide range of tools, and engagement by clinics and other services throughout Mercy, said Donna Smith, director of medical management business development and one of the leaders of the demonstration project.
“For example, patients with heart failure are automatically enrolled in an interactive voice response technology program. They call in daily to a recorded message, and answer a series of questions. If their responses are outside the parameters, the information goes to a nurse who then contacts them.
“We also do things as basic as giving patients an educational reference book that provides them one place to list their medications, numbers to call and a questions they want to ask the next time they visit their doctor,” Smith added. “We focus on collaboration between inpatient case management and the outpatient case manager, because in many cases these patients have multiple health conditions.”
The results were announced in Washington, D.C., by the Centers for Medicare and Medicaid Services. CMS oversees the Medicare system and launched this demonstration project to promote investment in care management programs and redesigned care processes that might be used by doctors and hospitals nationwide.
Mercy St. John’s achieved both of the project’s aims: to provide the highest-quality care and reduce health care spending growth for all traditional Medicare patients, including those with costly chronic illnesses.
The other physician groups participating in the project are Billings Clinic, Billings, MT; Dartmouth-Hitchcock Clinic, Bedford, NH; The Everett Clinic, Everett, WA; Forsyth Medical Group, Winston-Salem, NC; Geisinger Clinic, Danville, PA; Marshfield Clinic, Marshfield, WI; Middlesex Health System, Middletown, CT; Park Nicollet Health Services, St. Louis Park, MN; and University of Michigan Health System, Ann Arbor, MI.