Marshfield Clinic in Wisconsin was one of two large physician groups of 10 participants in a federal quality improvement demonstration project that received shared savings during each of the five performance years. The clinic earned a shared savings payment of $15.8 million for the fifth year, which will be used to fund further changes and improvements, said Theodore Praxel, MD, medical director for the clinic's Institute for Quality, Innovation and Patient Safety. Marshfield earned a total of $56 million over the five performance years, according to CMS project documents. University of Michigan Faculty Group Practice was the other physician group that received shared savings in each of the five years, according to CMS. Marshfield Clinic said its ability to consistently drive quality while reducing Medicare costs was the result primarily of investing in a well-developed electronic health record and other tools to enable that improvement, some of it prior to the demonstration project.