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Trying to Get I.T. to Pay Off in P4P Programs
October 2007
Over the past 30 years, Marshfield (Wis.) Clinic has periodically tailored its homegrown electronic health records system and data warehouse to meet clinician workflow. But the impetus behind some recent modifications has been more about its bottom line.
About three years ago, the 725-physician group practice retooled the EHR to help it participate in the Medicare Physician Group Practice Demonstration, a pilot program that offers providers financial incentives for meeting specified clinical performance and cost benchmarks.
Before the April 1, 2005, program start date, Marshfield's I.T. staff developed PreServ, an application within the EHR that pulls information from the data warehouse to show physicians at the point of care if a patient needs any preventive services. They also developed iList, a tool within the data warehouse that enables physicians and nurses to see which chronic disease patients are most out of date with required tests and services.
Additionally, the clinic created a clinical "storyboard" application for the data warehouse to enable the practice to show physicians how their decisions affect clinical outcomes.
Last July, Medicare determined the practice had achieved target or better performance on seven of the 10 clinical measures specified for the first year of the program. Further, it estimated that Marshfield reduced Medicare costs by $6.03 million, and as a result, awarded it a $4.56 million bonus contingent upon it continuing a similar performance level during the remaining two years of the program.
Only two of the 10 participating group practices received bonuses for the first year. All the groups had EHRs, but it was Marshfield's ability to customize its system specifically for the project that gave it an advantage, says Jeremy Meller, clinic division CIO.
"Just having an EHR didn't necessarily help us meet the quality standards. It was the tools and processes we created behind the scenes that made the difference," Meller says. "But it would have been difficult to do without one."
About 35% of health plans-including Medicare-now offer some kind of pay-for-performance program, according to a May survey by Framingham, Mass.-based Health Industry Insights, a wholly owned subsidiary of research firm IDC.
These programs offer bonus payments if providers achieve specified benchmarks for various clinical quality metrics. Some also review claims or require providers to submit other evidence of reduced spending during the program.
To help collect and manage the massive amounts of data required for P4P programs, providers are using EHRs, practice management systems, and other clinical or data mining tools. And payers are using Web portals, managed care information systems or other data mining tools to administer them.
"There are two layers of I.T. necessary for P4P," says Janice Young, program director at Health Industry Insights. "There's a certain amount that's needed to amass the data you need to collect, and another amount to actually improve outcomes."
No Mandate
While 70% of payers that offer P4P programs say they encourage participants to use automated systems, most stop short of mandating it, according to the Health Industry Insights survey.
But while using I.T. is not necessarily a requirement, indications are that it certainly helps. For example, a July study by Integrated Healthcare Association, an Oakland, Calif.-based organization that operates a P4P program, found that group practices using I.T., such as electronic prescribing, automated drug interaction checks and preventive and chronic care reminders, scored 18% better on its various P4P clinical quality measurements than those that didn't.
Marshfield Clinic, fresh off earning its multi-million dollar P4P bonus, continues to add new software and develop related processes during the third and final year of the Medicare demonstration program
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