Twelve New Jersey hospitals achieved $113 million in health care savings during a three-year pilot project that encouraged hospitals and physicians to work together to provide more efficient, high-quality care, according to the New Jersey Hospital Association, which led the New Jersey Care Integration Consortium, also known as the “gainsharing” program.
The Medicare pilot program gave physicians financial incentives based on their performance on quality and efficiency metrics.
The program reduced costs per admission by roughly 8.5 percent. Of the total savings of nearly $113 million, about 17 percent (nearly $19 million) was paid out as physician incentive payments.
“In an environment where there are significant pressures downward on government revenue, and Medicare is a big part of any hospital’s business, this was an opportunity for the hospitals to coordinate care delivery with the doctors and for those doctors that performed and improved the quality of care to receive a modest financial bonus to do so,” said Sean Hopkins, NJHA’s senior vice president of health economics.
He said that, when the program ended in 2012, the Centers for Medicare and Medicaid Services launched a new program that built on the success of the New Jersey gainsharing pilot: “To a great extent, New Jersey hospitals have really been on the forefront of care coordination, improving the dialogue with all the providers.”
The new program, the CMS Bundled Payments for Care Improvement Initiative Model 1 Gainsharing Program, enrolled a new group of 16 New Jersey hospitals and is still ongoing, Hopkins said. Under that program, now in its second year, the hospitals are required to accept a reduction in the Medicare reimbursement in order to participate in gainsharing. The Medicare reduction was 0.25 percent in the first year and rose to 1 percent this year.
“Traditional Medicare protocols pay hospitals and physicians in different ways,” Hopkins said. “Hospitals receive a set rate for each patient case, regardless of how long a patient is hospitalized, while physicians are paid ‘a la carte’ for each test, procedure or patient day in the hospital. The gainsharing philosophy makes hospitals and physicians partners in identifying more efficient ways to deliver quality health care.”
The gainsharing pilot was featured by the U.S. Agency for Healthcare Research and Quality as an example of new models that are reforming the nation’s healthcare delivery system, according to NJHA.
“Healthcare is changing – no question – and New Jersey hospitals are committed to being leaders in that change,” said NJHA President and CEO Betsy Ryan.
The 12 original pilot hospitals were:
Hopkins said the original gainsharing program “was limited by CMS to 12 hospitals and 12 hospitals only. Many other New Jersey hospitals requested the opportunity to get in on the original demonstration. The Model 1 program provided many of these hospitals with their first opportunity to initiate the gainsharing program.”
The 16 hospitals in the new program are:
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