Leading Medical Groups Push Congress for Medical Home Reimbursement Options
By Emily Mullin
July 17, 2012
During a recent hearing on Capitol Hill, stakeholders urged Congress members to adopt a blended Medicare payment model that supports the medical home as a way to improve healthcare quality and control costs.
At a July 11 Senate Finance Committee meeting on Medicare physician payment strategies, American Academy of Family Physicians president Dr. Glen Stream said that while there is no single alternative payment method that will rebuild primary care, the medical home is an effective way of improving quality while controlling costs.
At the hearing, Stream participated in a five-member physician panel representing various areas of the medical community, including the American Medical Association, surgery, cardiac surgery and oncology.
"We absolutely have to build a strong primary care foundation if we are going to have any success at improving the quality and cost-effectiveness of our healthcare system," Stream said at the meeting.
Findings from medical home programs across the nation are demonstrating how the model can achieve the simultaneous goals of higher quality and cost control, said Stream. He called on Congress to adopt a blended payment methodology that includes a fee-for-service component, a care management fee and quality improvement payment.
"We need to pay primary care differently and better" to create a more efficient, high-functioning health system, said Stream. As an example, he cited a bipartisan bill introduced by Reps. Allyson Schwartz, D-Pa., and Joe Heck, R-Nev., that "takes a notable step toward recognizing the critical need to pay primary care differently." The bill would reform how Medicare pays healthcare providers and prevents a cut in physician reimbursement rates scheduled for Jan. 1, 2013. The measure would also replace Medicare's current pay formula, known as the “sustainable growth rate.”
Dr. Ardis Dee Hoven, president-elect of the American Medical Association, pointed out in his testimony that numerous innovations are being conducted in the private sector. For example, regional projects currently underway include an accountable care medical home program in Washington State and the Maine Health Management Coalition.
Hoven noted CareFirst’s patient-centered medical home as another innovative program that provides primary care physicians with incentives and tools to deliver higher quality care while lowering the cost of care. CareFirst recently announced that of the nearly 3,600 participating primary care providers caring for nearly a million patients, almost 60 percent of eligible PCMH “panels” earned additional reimbursements for their 2011 performance.
Hoven added that it’s important to change the curriculum at certain medical schools to put a greater emphasis on primary care.
Dr. W. Douglas Weaver of the American College of Cardiology said providing physicians and other healthcare providers with data on their performance as well as tools to help improve their performance drives up quality and efficiency and helps lower costs.
“The ACC supports moving the current Medicare physician payment system away from a volume-based system and toward a value-driven system that better aligns compensation with performance of evidence-based medicine and higher value, appropriate healthcare,” Weaver said in his written statement to Congress.
Dr. Barbara McAneny, CEO of New Mexico Oncology Hematology Consultants and a representative of the American Society of Clinical Oncology, said that the current fee-for-service model of payment is flawed because it does not reward judicious use of resources.
In her testimony, McAneny said the medical home model would benefit cancer patients because they typically require ongoing care for pre-existing medical conditions, whether from their primary care physician or other specialists. Coordination of this care is critical in order to ensure patient safety, high quality treatment, and patient satisfaction and engagement.
“A PCMH model has potential to provide real savings to both payers and patients. Such models emphasize consistent coordination of care, aggressive symptom management, increased access to qualified professionals via a system of telephone triage or electronic means, and increased patient engagement in care decisions,” she said.
McAneny’s practice, New Mexico Oncology Hematology Consultants, is the recent recipient of a grant by the Center for Medicare & Medicaid Innovation. Through this grant, seven community oncology practices across the country will conduct a three-year test of a medical home model of care delivery for patients with breast, lung, or colorectal cancer. The medical home will provide comprehensive outpatient oncology care, including patient education, team care, medication management, and 24/7 practice access and inpatient care coordination to improve the timeliness and appropriateness of care, reduce unnecessary testing, and reduce avoidable emergency room visits and hospitalizations.