Billings Clinic Continues to Improve Quality of Care Under Federal Demonstration Project

BILLINGS, MT – Billings Clinic has been recognized as one of the top performers in quality for conditions such as diabetes, congestive heart failure, high blood pressure, coronary artery disease, and preventive screenings for mammography and colonoscopy. The Centers for Medicare & Medicaid Services (CMS) recently announced that each of the ten physician groups participating in the Medicare Physician Group Practice (PGP) Demonstration improved performance on the delivery of preventive care and care for patients with chronic illnesses.

The PGP Demonstration provides incentives for better coordination of Medicare services, promotes the investment in care management programs and redesigned care processes, and rewards physicians for improving health outcomes. In 2007, The PGP Demonstration program integrated the Physician Quality and Reporting Initiative (PQRI) to allow organizations to report relevant quality measures for covered services furnished to Medicare beneficiaries. Billings Clinic significantly exceeded target goals on 98% of the quality measures and qualifies to receive a PQRI incentive payment of $348,000.

All ten of the participating physician groups - Billings Clinic, Everett Clinic, Dartmouth-Hitchcock Clinic, Forsyth Medical Group, Geisinger Clinic, Middlesex Health System, Marshfield Clinic, Park Nicollet Health Services, St. John’s Health System, and the University of Michigan Faculty Group Practice - achieved benchmark or target performance on at least 28 out of 32 quality measures reported in performance year 3. Billings Clinic achieved 31 of 32 measures, resulting in a 98% quality score for year three of the demonstration.

“Billings Clinic is very pleased with the quality improvements we have been able to implement as a member of this demonstration,” said Nicholas Wolter, MD, CEO of Billings Clinic. “Billings Clinic remains committed to providing quality care at an optimal cost and we appreciate the opportunity to work with the other participating sites to collectively learn strategies on ways to continue finding value in the delivery of care.”

Over the first three years of the demonstration, the physician groups increased their quality scores an average of 10 percentage points on the diabetes measures, 11 percentage points on the congestive heart failure measures, 6 percentage points on the coronary artery disease measures, 10 percentage points on the cancer screening measures, and 1 percentage point on the hypertension measures.

Billings Clinic continues to see success in the development of a Heart Failure program that closely monitors up to 500 patients, and has demonstrated a 40% reduction in hospitalizations for patients living with this disease. Although this service is not reimbursed, it is estimated to have saved Medicare close to $4 million in the 36 months of this demonstration.

Remarkable performance improvements were achieved at Billings Clinic through an investment in health information technology to provide the tools necessary to create patient registries and offer consistent evidence based care. The majority of eligible Internal Medicine and Endocrinology physicians have received the Diabetes Physician Recognition Program superior achievement designation administered by National Committee for Quality Assurance (NQCA) for their commitment in treating patients with diabetes.

Compared to other participating organizations, Billings Clinic has been able to offer a unique perspective on the results in this demonstration due to the extreme geographic dispersion of many of our patients. Approximately 50% of the Medicare patients attributed to the Billings Clinic group reside outside of Yellowstone County.