(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 34
payments for services rendered and offered an additional performance payment for
demonstrating "value". The performance payments were tied directly to achieving targets
for process and outcome quality measures as well as cost savings. The PGP
Demonstration showed that physician-driven organizations are willing to engage in
efforts to improve the overall quality and cost efficiency of care for the patient population
they serve. Under the demonstration, the PGPs were accountable for a patient population
to whom they provided the plurality of office-based evaluation and management care.
The assignment of patients to the PGP at the end of each performance year and data has
shown that assigned patients had on average four or five visits at the PGP during the year.
This provided the opportunity for the organizations to better coordinate services and
improve the quality and efficiency of care provided to Medicare FFS patients. Medicare
patients retained their entitlement to see any Medicare provider they chose and were not
enrolled or required to only see PGP physicians under the demonstration.
Based on their experience with the PGP demonstration, participants identified several
factors as critical to improving quality and the opportunity to share savings:
• An integrated organization with an environment that supports expending
resources on multiple programs and initiatives to improve quality and reduce unnecessary
services.
• Dedicated physician leadership with a proven ability to motivate physicians to
participate in the development and implementation of quality improvement and other
clinical programs and initiatives.
• Health information technology that facilitates the aggregation and analysis of
data, allows patient-level feedback, and provides alerts and reminders at the point of care.