A Patient-Centered Medical Home (or PCMH) is not just a place; it’s so much more. It’s a comprehensive model in which a patient’s needs are coordinated through their primary care physician who works with the patient, and their caregivers, to obtain the best possible health outcomes.
Cooper Family Medical (CFM) in Bradenton, FL, recently attained PCMH recognition. The result: enhanced reimbursement, better patient access and care coordination, improved provider and patient satisfaction, and stronger outcomes.
According to FAFP member and CFM provider James Pineno, MD, “We were approached by our local Florida Blue Network Manager who said, ‘Your practice is already doing 99% of what is necessary to become a Medical Home. Why don’t you get the recognition?’“
CFM enrolled in their commercial insurance payer's PCMH Program, which provided funding to help with the costs of attaining PCMH recognition. Now, with recognition in hand, CFM receives significantly enhanced reimbursement from their payer.
As a benefit of membership, Dr. Pineno and CFM also received a rebate from FAFP to help offset education and consulting assistance, which they attained through The Center for the Advancement of Health IT (AHIT). In October 2017, Dr. Pineno and his team achieved Medical Home recognition under NCQA.1
Additional financial incentives are also available for qualifying practices through Medicaid and Medicare. If a practice sees Medicaid patients, eligible primary care providers who are PCMH recognized can participate in the Agency for Health Care Administration’s (AHCA’s) Managed Medical Assistance Physician Incentive Program (MPIP)2 to receive the Medicare reimbursement rate for Medicaid encounters. In many cases, PCMH providers who participate in MPIP can double their reimbursement rate on qualifying encounters.
Medicare does not provide enhanced reimbursement just for being a Medical Home like the Medicaid plans do, however under the Merit-based Incentive Payment System (MIPS) there are four categories on which practices are scored. One of those categories, “Improvement Activities”, requires practices to submit proof they are performing a selection of predetermined activities to improve the practice. According to Cortnie Fricot, Practice Advisor for AHIT, “If your practice is recognized as a Medical Home, you can earn full credit for this category without having to submit any of the activities from the list. Earning full credit can result in enhanced scoring and reimbursement.”
A Medical Home practice can also leverage their recognition with other payers. Strong care indicators, improved health outcomes, and demonstrative reduced expenses arm a practice with tools to negotiate favorable payer contracts.
“Certainly, the financial benefit to achieving recognition is valued,” says Dr. Pineno. “It helps to defray the costs associated with delivering a high level of care, and offsets some of the reduced reimbursements we've all dealt with.”
Improved Access, Care Coordination, and Outcomes
According to Dr. Pineno, “One of the objectives of PCMH is to provide patients with greater access to us, their primary physicians, as well as specialists on their 'care team.' Our relationships with our partners in the medical community allow our patients enhanced access, less waiting, and ultimately better outcomes. Patients appreciate the fact that we have nearly instantaneous access to results of all interventions,” he says. “Our patients have developed confidence in all our staff to have answers to their questions, or direct them appropriately to those staff members who will have the answers. Medical Homes also offer extended hours, which give patients who work and struggle to find time for visits, greater access, and therefore, no excuses,” he says.
Embracing Medical Home Transformation
While CFM continues to build their specialist ‘partners’, they plan to focus on greater inclusion of patient values and cultures when helping them choose the right course for their patient’s care. “We will continue to stress the importance of having their families as core members of the team and ensure that we are keeping those family members informed of changes in the patient’s health,” says Dr. Pineno.
Enhanced Practice Marketing
If a practice is in an area where there are not many other Medical Home providers, this gives them a competitive marketing advantage. Patient engagement and satisfaction tends to be higher in Medical Home practices.3,4 It also helps when recruiting providers who can add Medical Home experience to their credentials. “We’ve been embracing the Medical Home concept for years and have consistently been voted the ‘People’s Choice Award Winner for Favorite Family Doctors’ in our area for the 10th consecutive year!” says Dr. Pineno.
Critical Factors for Success
According to CFM’s Practice Administrator Bonnie Rossi, “The MOST critical factor for our success was 'buy in' from all providers and staff, all of whom recognized the benefit to our patients, and who had been indoctrinated to Meaningful Use for the previous 5 years, and understood the scope of the project, and their individual roles in its inevitable success,” she says. “Equally important was our partnership with The Center for the Advancement of Health IT (AHIT) in guiding us through the tedious (and often confusing) recognition process. Without AHIT, we would not have been successful. Their ability to interpret the guidelines into a language that made sense was invaluable. AHIT had previously guided us through Meaningful Use and we had total confidence in their ability to do the same for the PCMH recognition.”
Considering Becoming a Medical Home?
Rossi advises, “It’s tedious. Be sure to have as many employees dedicated to the project as is feasible and plan weekly meetings to keep abreast of the progress or any issues that arise. The process of working toward a Medical Home is by far the greatest ‘team building’ experience within a practice. You will engage every member of your staff in some aspect of the patient’s care – whether it’s your scheduling/call center who will focus on the importance of access to the providers, or your Medical Assistances/Nursing staff’s morning ‘huddle’ to plan their day with patients and offer any insight to specific patient needs. Everyone has a role in assuring the patients you will see that day will experience an appointment that answers questions, addresses concerns, and promotes greater access to community partners/coordinated care that ultimately moves patients to the best health possible. Your patients may even lose their fear of that ‘dreaded doctor visit’.”
Dr. Pineno recommends that practices considering PCMH get help from resources that are available and take advantage of the many financial incentives that can help offset the cost. “The FAFP PCMH Incentive Program can help to defray the costs of instituting PCMH into a practice and makes the entire process far more palatable,” he says. “The goal is to deliver the best possible care and experience to all patients – a sentiment that is synonymous with FAFP’s ideology.”
For more information or to apply for the FAFP’s PCMH Incentive Program, which provides a $3,000 rebate for PCMH assistance, contact Jennifer Young at FAFP at email@example.com or (904) 726-0944.
1 For more information on NCQA’s PCMH recognition program please visit: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh
2 For more information on the Agency for Health Care Administration’s (AHCA’s) Managed Medical Assistance Physician Incentive Program please visit: http://ahca.myflorida.com/medicaid/statewide_mc/qualified_providers_2017-18.shtml
3 Reid Robert J, Coleman Katie, Johnson Eric A, et al. “The Group Health Medical Home At Year Two: Cost Savings, Higher Patient Satisfaction, And Less Burnout For Providers.” Health Affairs. 2010; 29(5). Available from: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.0158
4 Nelson Karin M., Helfrich Christian, et al. “Implementation of the Patient-Centered Medical Home in the Veterans Health Administration Associations With Patient Satisfaction, Quality of Care, Staff Burnout, and Hospital and Emergency Department Use.” JAMA. 2014; 174(8): 1350-1358. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1881931