Marshfield Clinic demonstrates improved quality of care resulting in cost savings for Medicare

MARSHFIELD, WI – Marshfield Clinic has again been recognized for improving the quality of care while decreasing health care costs in the second year of a four-year Center for Medicare & Medicaid Services (CMS) demonstration project.

Announcement of these results was made today by CMS.

Medicare beneficiaries who received most of their care in the Marshfield Clinic system, which includes more than 40 sites in Wisconsin, experienced improved quality of care at a lower cost to the federal Medicare program as compared to Medicare beneficiaries receiving their care in the same geographic region from other providers.

CMS, part of the U.S. Department of Health and Human Services, initiated this Physician Group Practice (PGP) Demonstration to allow physician groups to prove that providing proactive, coordinated care can also save money.

Ten large group practices across the country are involved in the demonstration. The project was originally developed as a three-year effort and received an extension for a fourth year.

 “Everyone is affected by rising health care costs, so Marshfield Clinic is especially pleased to demonstrate for a second year in a row that we can provide savings for the Medicare program while further improving quality of care for our patients,” said Theodore A. Praxel, M.D., M.M.M., FACP, Marshfield Clinic medical director of Quality Improvement and Care Management. “Health care is a rapidly changing field, and participation in this project helps us learn ways to more quickly advance the value of the care we deliver to all our patients at Marshfield Clinic.

“While the 10 participating group practices showed lower growth in Medicare expenditures collectively, Marshfield Clinic was one of four to generate significant savings under the terms of the demonstration that resulted in a performance payment. All 10 participating sites showed improvement in the quality outcomes measured in this second year.”

In the first year of the project, 10 measures for quality outcomes were reported and two participating sites – Marshfield Clinic and University of Michigan Faculty Group Practice – generated adequate savings to earn a performance payment.

In the second year, 27 measures for quality outcomes were reported to CMS for diabetes, congestive heart failure and coronary artery disease. Marshfield Clinic achieved benchmark performance on 100 percent of those quality measures. Four sites – Marshfield Clinic, Dartmouth-Hitchcock Clinic, The Everett Clinic and the University of Michigan Faculty Group Practice – received a performance payment for improving quality and efficiency of care.

An independent third party determined that Marshfield Clinic did better in controlling the growth in Medicare spending than its comparison group – other health care providers located in the same geographic region as Marshfield Clinic – by providing services in a more cost-effective manner resulting in savings to Medicare while at the same time improving quality outcomes.

“Marshfield Clinic is gratified that it has achieved 100 percent of the quality measures. These results speak well for all Marshfield Clinic physicians and staff members,” said Marilyn A. Follen, R.N., M.S.N., Marshfield Clinic administrator of Quality Improvement and Care Management. “While our patients were receiving quality care prior to the project, our participation has further enhanced that quality and demonstrated our cost effectiveness. Most important, the knowledge gained in quality improvement and cost savings achieved through this demonstration project benefits all Marshfield Clinic patients, not just our assigned Medicare beneficiaries.”

“Marshfield Clinic is committed to improving the value we deliver to our patients and our participation in this demonstration project reflects our goal to lower costs yet provide high quality outcomes,” said Karl Ulrich, M.D., M.M.M., Marshfield Clinic president and chief executive officer. “Our care management efforts, which include a 24-hour nurse line as well as anticoagulation, congestive heart failure and cholesterol management programs, allow our physicians and staff to work as a cohesive team to benefit all our patients.”

Marshfield Clinic has made substantial investments to develop necessary tools to improve quality of care delivered to patients, even prior to this project. For example, Marshfield Clinic has a well-established telemedicine initiative; a telephone nurse line for advice and triage; and is a pioneer in developing an electronic health record (EHR). All physicians in the Clinic system have access to patient records from all Clinic centers through the EHR, which helps to eliminate rework on lab tests, imaging and more. The EHR assists in planning visits; addressing care at the time of the visit; and assuring appropriate monitoring of chronic conditions is performed.

“Marshfield Clinic’s sophisticated EHR was necessary for our success, but it would not have been enough without efforts of physicians and staff to integrate the EHR into patient care,” Praxel said. “The EHR helps make care more efficient since all results, notes and studies completed at Marshfield Clinic sites are available throughout the Clinic system. This helps decrease repeat testing and improve coordination of care between caregivers, no matter where in the Clinic system patients are located.”

CMS Demonstration Project results being reported measure the second year of the project – April 1, 2006, to March 31, 2007. The project is scheduled to conclude in March 2009. Marshfield Clinic has approximately 35,000 people assigned by CMS. This is the largest group of beneficiaries in the project, with an overall total of about 225,000 participants.

“We are pleased that we have been successful at efficiently using our resources for our patients’ benefit. We are always looking to develop new methods to help our patients and staff to further improve care. While we are delighted with these results, we will continue to work to improve our results in future years,” Praxel said.

Marshfield Clinic will receive a performance payment from CMS of $5.78 million, with $4.33 million this year and $1.44 million sometime in 2010, if current demonstrated success in the project to date continues. This is a result of sharing savings of $7,226,966 to the Medicare trust funds, under the terms and conditions of the project, based on the Clinic’s demonstrated efficiency and quality of care measures, resulting in lower Medicare expenditures with total actual savings to Medicare of $13,124,654.

The Marshfield Clinic system provides patient care, research and education with more than 40 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States.

EDITORS NOTE: Of the 26 physician groups that applied through the competitive application process, 10 sites across the country were selected. Those selected besides Marshfield Clinic were:

Dartmouth-Hitchcock Clinic, Bedford, New Hampshire

Deaconess Billings Clinic, Billings, Montana

The Everett Clinic, Everett, Washington

Geisinger Clinic, Danville, Pennsylvania

Integrated Resources for the Middlesex Area, LLC, Middletown, Connecticut

Forsyth Medical Group, Winston-Salem, North Carolina

Park Nicollet Health Services, St. Louis Park, Minnesota

St. John’s Health System, Springfield, Missouri

University of Michigan Faculty Group Practice, Ann Arbor, Michigan.