Credibility of CMS Physician Study Questioned

Published November 1, 2008

The Center for Medicare and Medicaid Services (CMS) has released a glowing evaluation of year two of its four-year pilot program that pays physicians based on quality and efficiency of care.

CMS reports all 10 groups participating in the Physician Group Practice (PGP) demonstration showed improvement in quality of care, and four were able to cut costs by an aggregate $17.4 million.

Some policy analysts have questioned the credibility of the study, with one going so far as to call it “fabricated research,” in part because all that was monitored was whether participating doctors actually accomplished certain clearly defined tasks, instead of comprehensively evaluating overall quality of care.

‘Fabricated Research’

“This is an example of fabricated research,” said Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute. “Where is the control group? Where is the historical record? Where is the information about actual outcomes rather than mere filling in boxes on a form? Essentially CMS told these groups, ‘We’ll give you more money if you fill in these boxes.’ Of course the boxes got filled in.

“No Child Left Behind has been slammed for getting schools to ‘teach to the test,’ ” Scandlen noted. “This program has bribed physicians to ‘practice medicine to the form.'”

Considered Incentives

PGP was initiated in 2005 to determine whether incentivizing doctors to provide quality-driven services would increase patient care and ultimately reduce costs.

Each of the physician groups faced a 27-point quality measurement test upon which, for the purpose of the study, their entire performance was evaluated. Participants agreed to place their Physician Quality Reporting Initiative (PQRI) incentive payments on the table with the understanding they would receive payment upon successful completion of the program.

In an August 14 statement, CMS said the physicians involved in the program “improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus during performance year 2 of the demonstration.”

All 10 practices successfully received their incentive payments. CMS reported, “All physician groups received at least 96 percent of their PQRI incentive payments, with five groups earning 100 percent of their incentive payments. A total of $2.9 million in PQRI incentive payments was paid out to the 10 groups under the demonstration.”

In addition to the incentive-based structure, much of the success of PGP can be attributed to the right blend of physicians who undertook the challenge, according to CMS.

Integrated Telemedicine

The groups’ reported care quality improvements also can be credited to their use of electronic health records, said a source close to PGP, because such records improve communication, coordination, and quality for both patients and medical practitioners.

The use of the technology saved time and money during the course of the PGP demonstration, said the source close to the study, because it allowed the working group to stay on the same page and to communicate and coordinate more effectively.

Katie Flanigan ([email protected]) writes from Georgia.