MMA649_Eval

Evaluation of the Medicare Care Management Performance Demonstration
Section 649 of the Medicare Modernization Act, which authorized the
Medicare Care Management Performance Demonstration, requires
that, no later than 12 months after the completion of the
demonstration program, the Secretary shall submit a report to
Congress on the demonstration along with recommendations for
legislation and administrative action as appropriate. To fulfill this
requirement and the legislative requirement for an evaluation of
physicians’ performance under the demonstration program, CMS and
the Agency for Healthcare Research and Quality contracted with
Mathematica Policy Research, Inc. to conduct an independent
evaluation of the demonstration.
A non-randomized, matched comparison group of small- to mediumsize physician practices will be used for the evaluation. The
comparison practices will be selected from participating DOQ-IT
practices in states other than the four participating in the MCMP
demonstration. The comparison and demonstration practices will be
matched on specific criteria, such as practice size, experience with
EHRs, and pre-enrollment outcome measures, including patient
hospitalizations and Medicare expenditures. The primary difference
between the practices will be that the demonstration practices will
receive a financial incentive for meeting clinical performance standards
whereas the comparison practices will not.
Using Medicare claims data and results from patient and physician
surveys, the demonstration and comparison practices will be compared
to assess the effects of the financial incentive for performance
improvement on continuity of care, health outcomes, quality of care,
patient satisfaction with care, physician satisfaction, and Medicare
expenditures. An office system survey, to be collected by the QIOs,
will be used to compare the demonstration and comparison practices
to explore the effect of the demonstration on progressive
implementation and use of various aspects of EHRs.
An
implementation analysis, using information from site visits to the
demonstration practices, will look at the experiences of the
demonstration practices in implementing and using an EHR, identify
barriers and facilitators to the adoption and use of an EHR, and include
physicians’ perception about the effects of the demonstration on their
practice and patients. The evaluation will also explore whether there
were any changes or improvement over time in practice performance
and which practice characteristics are associated with improved health
outcomes. The evaluation will run for four years.