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  1. #1
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    Default What is status of PCMH in your neighborhood?

    Healthcare is on the precipice of a major shift attempting to lower costs while improving quality and satisfaction. The only practices I have seen achieve this were ones that truly implemented the principles of the Patient Centered Medical Home. BTW, PCMH is Patient-Centered and not Process-Centered. Unfortunately, the later seems to be more prevalent than the former.
    NCQA has become the preeminent recognizer of practices for PCMH, and are soon going to be recognizing Patient Centered Specialty Practices (PCSP) as well.
    Via DOCS CPR, a PCMH/PCSP toolkit is being developed that is in alignment with the NCQA standards. Several using the SOAPware EHR have achieved Level 3 PCMH recognition from NCQA, and we see that facilitating our users in this area is likely going to be a key to success in the near future.
    Every region of the country and every practice is a little different in regards to this transition. Some payers are offering incentives to facilitate the practice transformations/recognition. What is happening in your practice and community?

  2. #2
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    What is happening in your practice and community?

    I am aware of a few local practices which are PCMH certified. Interestingly, the practice that is Level III certified is a hospital owned practice which recieved a 1.5 mil grant to pursue this. Financially, I do not think they break even, even with the grant.

    The second issue is reimbursement for these efforts. There are several insurers starting to reimburse for the effort at 2-3$ pmpm on top of fee for service. A good estimate of the real true cost for managing care (not just doing the same thing and the other management in your free time) is estimated around $15 pmpm on top of the fee for service charges. I think if the true costs are not realized, this certification and management process will just squeeze practices further.

    The concept of a medical home is an important step further in good patient management. Unless the true costs are reimbursed the feasibility of maintaining this , may be limited.




  3. #3
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    Quote Originally Posted by DoctorW View Post
    What is happening in your practice and community?

    I am aware of a few local practices which are PCMH certified. Interestingly, the practice that is Level III certified is a hospital owned practice which recieved a 1.5 mil grant to pursue this. Financially, I do not think they break even, even with the grant.

    The second issue is reimbursement for these efforts. There are several insurers starting to reimburse for the effort at 2-3$ pmpm on top of fee for service. A good estimate of the real true cost for managing care (not just doing the same thing and the other management in your free time) is estimated around $15 pmpm on top of the fee for service charges. I think if the true costs are not realized, this certification and management process will just squeeze practices further.

    The concept of a medical home is an important step further in good patient management. Unless the true costs are reimbursed the feasibility of maintaining this , may be limited.



    Yes, Process-Centered Medical Homes are not proving cost-effective. They typically just layer in extra work for the physicians which lowers their capacity, satisfaction, and economic viability. The key to Patient Centerdness and success is to transform workflows to engage and delegate tasks to patients and the practice team which results in the removal of documentation and administrative tasks from the docs. I have visited dozens of practices where the docs have been transformed into being able to focus on being doctors again, and are able to manage much larger patient populations with less work and higher quality and satisfaction. This transformation can really bring back the joy in medicine, and it is actually possible for a practice to thrive financially even without added incentives. I recently visited a large practice that is PCMH recognized that had the happiest group of docs I have seen in a long time. They are not only thriving, but their group is rapidly growing. Because the costs for their care has been significantly less than the other, larger multi-specialty group in town, the main health plan in the region recently cancelled the contract with the larger group. Overnight, that group saw an 80% reduction in patient volume which is now going to the PCMH recognized practices. I see this as a likely scenario in many locales in the near future.
    Last edited by roates; 03-14-2013 at 07:08.

 

 

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