• Patient-centered medical homes need a new reimbursement model

    Patient-centered medical homes (PCMHs) seek to re-organize how patients with complex treatment plans interact with the health sector. First, the bad news: high-quality PCMHs cost more money. From Nocon et al. in JAMA this week:

    Before any PCMH-haters cheer, note carefully the definition of “cost” used in the study:

    It is critical to understand the cost of the PCMH from the perspective of individual clinics. Such cost data are essential for practices to make informed decisions to adopt the PCMH and for policy makers and administrators to design financially sustainable medical home models. Most PCMH cost studies have focused on potential savings from reducing hospitalizations and emergency department visits. Although those are important cost outcomes, the savings accrue to payers and rarely affect the finances of the primary care provider. The majority of US primary care physicians do not benefit financially from prevented hospitalizations or emergency department visits. (emphasis added)

    This research suggests that PCMHs save money for health plans, but not for the doctors & clinics themselves. Public and private payers will have to change the way they pay PCMHs if they expect doctors to embrace the model.

    @koutterson

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    • I don’t know about other places, but we get a percent uplift from our payers on E&M codes by being PCMH “certified” either from the payer and/or NCQA.