Marshfield Clinic saves Medicare $83M

The Marshfield Clinic has reportedly saved Medicare $83 million over four years through its participation in a demonstration project on providing quality care.

The clinic system provides patient care, research and education at 52 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States. It is one of 10 large physician groups taking part in the Medicare project.

The Centers for Medicare and Medicaid Services demonstration project challenged the participating physician practices to prove that providing high-quality, coordinated healthcare could also save money.

CMS officials announced Friday that, in the fourth performance year of the five-year project, the Marshfield Clinic has  improved the quality of healthcare it delivers to patients while decreasing healthcare costs.

"It has taken a lot of hard work by clinic staff as we continually strive to improve care, but that work has been rewarded as the clinic this year exceeded 100 percent of the quality measures," said Theodore A. Praxel, MD, the clinic's medical director of quality improvement and care management. "We're pleased to show, for a fourth year, our success in efficiently using healthcare resources for the benefit of all the patients we serve, but we will continue to look for other ways to improve."

Only two of the 10 participating practices have achieved this honor in each of the four performance years, according to CMS officials.

"Marshfield Clinic has believed for a number of years that if we were to be successful in decreasing costs and further improving the quality of care delivered to patients, we would need to look at how we can deliver care in new ways," said Praxel. "This why we committed to be a part of the Physician Group Practice Demonstration project."

While the 10 participating group practices showed lower growth in Medicare expenditures collectively in the fourth performance year, the Marshfield Clinic was one of five to generate significant savings under the terms of the demonstration that resulted in a performance payment. Other sites receiving performance payments were the Dartmouth-Hitchcock Clinic in Bedford, NH., the Geisinger Health System, in Danville, Pa., the St. John's Health System in Springfield, Mo., and the University of Michigan Faculty Group Practice in Ann Arbor, Mich.

"The clinic is receiving a bonus payment of about $16.15 million which will be used to fund further changes and improvements in how Marshfield Clinic delivers care to all of our patients," Praxel said. "The performance payment Marshfield Clinic receives will allow us to continue beneficial healthcare activities that are not currently reimbursed by most insurers right now."

Officials said the Marshfiled Clinic made substantial investments to develop tools to improve the quality of care delivered to patients, even prior to the project. They include:

• A well-developed electronic health record. All Marshfield  physicians have access to patient records from all clinic centers through the EHR, which helps to eliminate duplication of services such as lab tests and imaging. The EHR helps plan visits, addresses care at the time of the visit and assures appropriate monitoring of chronic conditions is performed.
• A 24-7 telephone nurse line for advice and triage for patients who have their primary care provider within the Marshfield Clinic system.
• An anticoagulation clinic.
• Congestive heart failure clinic programs.
• Cholesterol management programs.
• A well-established telemedicine initiative

Changes implemented as a result of participation in the demonstration project are not limited to Medicare beneficiaries, but are applied to all Marshfield Clinic patients, officials said.

"The entire Marshfield Clinic organization is committed to doing the hard work as a team to improve the value we deliver for all patients," said Karl Ulrich, MD, the clinic'spresident and CEO. "While this work is difficult, it is an important part of healthcare reform and it proves that we can reduce costs without compromising the high quality care all of our patients receive at Marshfield Clinic."

In the fourth performance year, Marshfield Clinic has more than 35,000 people assigned by CMS, the largest group of beneficiaries in the project, with an overall total of about 225,000 participants.

"We're delighted that the care delivery approach we instituted has been successful in providing quality care to patients as well as savings to CMS in all four years of the project," said Marilyn A. Follen, a nurse and administrator of quality improvement and care management at the clinic. "The outstanding efforts of our physicians and staff during the fourth performance year allowed Marshfield Clinic to improve the efficiency of care delivery and to exceed 100 percent of the quality measures set by CMS. This resulted in more than $35 million in savings to CMS in the fourth year. These results speak well for the dedication and hard work of all clinic physicians and staff members."

In the fourth year, participating large group practices reported 32 measures for diabetes, congestive heart failure, coronary artery disease, hypertension and cancer screening. In year four, three of the 10 sites met all 32 quality measures.

The CMS Physician Group Practice Demonstration project concluded on March 31, 2010.

Of the 26 physician groups that applied through the competitive application process, 10 sites across the country were selected for the initial three-year project, which was extended to five years. They are:

• Billings Clinic, Billings, Mont.;
• Dartmouth-Hitchcock Clinic, Bedford, N.H.;
• The Everett Clinic, Everett, Wash.;
• Forsyth Medical Group, Winston-Salem, N.C.;
• Geisinger Health System, Danville, Pa.;
• Marshfield Clinic, Marshfield, Wis.;
• Middlesex Health System, Middletown, Conn.;
• Park Nicollet Health Services, St. Louis Park, Minn.;
• St. John's Health System, Springfield, Mo; and
• University of Michigan Faculty Group Practice, Ann Arbor, Mich.