Medicare Compliance & Reimbursement

Better treatment needn't necessarily come at a steeper price. This seems to be the hopeful find from a report by the University of Michigan's Faculty Group Practice. The report, based on the facility's participation in the Medicare Physician Group Practice Demonstration is Medicare's first Pay for Performance Demonstration Project to work directly with physician groups.

The short of it: Older patients with heart disease and diabetes are getting better treatment than ever at the U-M Health System -- even while U-M's care for Medicare patients is costing less, the report shows. The data come from the second year of a national project undertaken by 10 large physician groups, including the U-M FGP, says a report published Aug. 15 on the Medical News Today Web site.

U-M claims that it was one of only two participating groups that achieved both of the project's aims: namely, to provide the highest-quality care on all 27 of the project's heart and diabetes measures, and to contain healthcare spending growth for all traditional Medicare patients, including those with costly chronic illnesses.

The U-M FGP, part of the U-M Medical School, includes all 1,500 U-M faculty physicians who care for patients at the three U-M hospitals and 40 U-M health centers. Many of the programs and innovations that U-M put in place for this project involved not only physicians but nurses, social workers, care managers and others who are involved in caring for Medicare patients at all U-M facilities, according to the report.

The report collates data from approximately 20,000 Medicare participants who received nearly all their care at U-M during the year that began April 1, 2006. It excludes those who were enrolled in a Medicare Advantage plan offered by a private health plan and Medicare participants who received only limited care at U-M.

The demonstration project at U-M began by focusing on the quality of care of patients with diabetes, but in the second year it was expanded to include heart failure and coronary artery disease -- both of which carry a high risk of emergency hospitalization and other care if not managed properly.

U-M is also participating in another Medicare performance incentive project, the Physician Quality Reporting Initiative (PQRI). In fact, U-M earned $460,000 for achieving high-quality care on 27 benchmarks through PQRI.

Why U-M's newsworthy success? It's due to the facility's effort to redesign the way patients are cared for, to enhance coordination and efficiency, and reduce the need for emergency care and repeat hospital stays, the report claims.

Some of the tactics that U-M has implemented to help improve care for Medicare patients include sub-acute care service, which brings U-M physicians and nurse practitioners specializing in geriatric care directly into certain nursing homes in certain areas of Michigan. U-M also put a strong focus on follow-up care in the home. U-M's CHOICES (Creating Healthcare Options to Inpatient Care and Emergency Services) program provides a nurse practitioner and social worker who can travel to a patient's home soon after he goes home from the hospital, to help with issues such as diabetes management.

Other measures implemented by U-M include Expanded Inpatient Geriatrics Consult Service and Emergency Medicine Consult/Referral Service.