The purpose of the project, part of a large multipayer initiative that used several types of support, is to determine how offering care-management fees affects the cost and quality of care provided in approximately 500 primary care practices taking part in the initiative. Unfortunately, despite having paid the participating practices a median of $115 000 per clinician in care-management fees over 2 years, the midterm assessment found that practices have not demonstrated any net savings after taking the incentive payments into consideration.
This is not surprising. Other pilot projects (including the Medicare Group Practice Demonstration (http://1.usa.gov/1sah9cB
) and the CMMI’s Pioneer Accountable Care Organization [ACO] initiative [http://1.usa.gov/25whmq2
]) have shown that it is challenging even for large, seasoned group practices to produce savings (http://bit.ly/1YZVbUa
More surprising was the finding that the practices participating in the Comprehensive Primary Care initiative have not shown many appreciable quality improvements to date.
In contrast, the Medicare Group Practice Demonstration (http://1.usa.gov/1UdKzQj
) and many of the ACOs (http://bit.ly/1KDhzJW
) have reported quality improvements.
They also indicate even their estimate falls short of the true incidence of medical error–related deaths because it is based on inpatient deaths only and because of errors in the health records.
The BMJ study suggests several strategies to reduce medical error deaths, but one of its major points is the need for more reliable data than is currently available. The problem is that current reporting of causes of death requires one or more International Classification of Death (ICD) codes to be put on the death certificate. But there are no ICD codes for human and system errors. At best, there are a few codes where medical error can be inferred, such as anticoagulation medication causing adverse effects.
I’m not suggesting that finding out what doesn’t work isn’t critical to finding out what will work. I’m also not suggesting that there has been a lack of will or interest in tackling either of these areas. But it is hard to ignore that there is little evidence that we’ve made much measurable progress in addressing these problems.