Medicare Physician Payment: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May Be Limited

United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2008-02-15 monographic deposited born digital 57 p. GA 1.13:GAO-08-65 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-08-65 P0b002ee180384655 f:d0865 DGPO 2010-08-12 2011-03-24 GAOREPORTS-GAO-08-65 machine generated eng fdlp REPORT GAOREPORTS-GAO-08-65 GAO-08-65 Fee-for-service plans Fees Health care cost control Health care costs Health care programs Health care reform Health policy Medicaid Medicare Payments Performance management Performance measures Physicians Program evaluation Program management Quality assurance Quality control Quality improvement Strategic planning Total quality management Medicaid Program Medicare Program Other Written Product A80833 Medicare Physician Payment: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May Be Limited Congress mandated in 2000 that the Centers for Medicare & Medicaid Services (CMS) conduct the Physician Group Practice (PGP) Demonstration to test a hybrid payment methodology for physician groups that combines Medicare fee-for-service payments with new incentive payments. The 10 participants, with 200 or more physicians each, may earn annual bonus incentive payments by achieving cost savings and meeting quality targets set by CMS in the demonstration that began in April 2005. In July 2007, CMS reported that in the first performance year (PY1), 2 participants earned combined bonuses of approximately $7.4 million, and all 10 achieved most of the quality targets. Congress mandated that GAO evaluate the demonstration. GAO examined, for PY1, the programs used, whether the design was reasonable, and the potential challenges in broadening the payment approach used in the demonstration to other physician groups. To do so, GAO reviewed CMS documents, surveyed all 10 groups, and conducted interviews and site visits. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-08-65/html/GAOREPORTS-GAO-08-65.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-08-65/pdf/GAOREPORTS-GAO-08-65.pdf GAO-08-65 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-08-65 Other Written Product GAO-08-65; Medicare Physician Payment: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May Be Limited; Fee-for-service plans Fees Health care cost control Health care costs Health care programs Health care reform Health policy Medicaid Medicare Payments Performance management Performance measures Physicians Program evaluation Program management Quality assurance Quality control Quality improvement Strategic planning Total quality management Medicaid Program Medicare Program United States Statutes at Large Volume 81 Page 821 81 Stat. 821 United States Statutes at Large Volume 111 Page 251 111 Stat. 251 United States Statutes at Large Volume 114 Page 2763 114 Stat. 2763 United States Statutes at Large Volume 117 Page 2066 117 Stat. 2066 United States Statutes at Large Volume 120 Page 4 120 Stat. 4 United States Public Law 248 (90th Congress) Public Law 90-248 United States Public Law 603 (92nd Congress) Public Law 92-603 United States Public Law 33 (105th Congress) Public Law 105-33 United States Public Law 554 (106th Congress) Public Law 106-554 United States Public Law 173 (108th Congress) Public Law 108-173 United States Public Law 171 (109th Congress) Public Law 109-171