Can the Patient Centered Medical Home Be Saved?

Posted by Michael Renzi, DO, FACP on Oct 10, 2017 9:01:00 AM

Yes – but only if insurers do their part.

Thousands of primary care providers transformed their practices to patient-centered medical homes in preparation for performance-based payment models. No doubt some groups submitted NCQA application for PCMH recognition status, but little changed in their day-to-day work flow. They just churned through as many patients as possible because their fee-for-service payments remained the key to their economic survival.

However, some of us actually made substantial investments in how we delivered patient care. We believed these new payment models promised to economically align payers, providers and, dare we even say it, patients. We examined and changed everything we did to prepare, with the full understanding that we were going to risk our payment if we missed the mark on quality and cost. We even considered alternative payment models (APMs), where we would pay money back to the payer if we missed the mark. Of course, these opportunities were touted to yield much bigger payments than the best of the fee-for-service contracts, but who would have ever “thunk it” -- doctors leaping head first into a risk-based payment model where they might have to refund payments to the payer for failure to meet cost benchmarks!

At first, it worked. High-performing practicesimprove patient outcomes and experience and lower the overall costs of care.[1] But in many markets, the APMs that would provide long-term economic sustainability to these high-performing groups never materialized.

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Topics: Value-Based Healthcare, Patient-Centered Medical Home, APMs

New Medicare reporting requirements: MACRA, MIPS & APMs Key Dates & Deadlines

Posted by Continuum on Feb 28, 2017 11:00:00 AM

As many physicians are aware, major changes are underway in how Medicare will reimburse them. The Centers for Medicare and Medicaid Services (CMS) is phasing in new reporting requirements focusing on “value” of care: measures of quality, overall cost of care, and patient satisfaction. Increasingly, how doctors address these new requirements will directly affect their reimbursement – potentially leading to financial rewards or penalties. Moreover, commercial payers are starting to follow Medicare’s lead. 

Here’s a quick refresher on the basics, including important dates for most physicians who see Medicare patients:  

  • The Medicare Access & CHIP Authorization Act (MACRA) of 2015 requires doctors to choose a reporting path – either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM).
  • MIPS is comprised of Quality, Improvement Activities, Advancing Care Information, and Cost. MIPS payment adjustments will start at +/-4% for the 2017 reporting year (2019 payment year) and increase over time. (Cost will not affect payment adjustments until 2018).
  • Advanced APMs offer higher financial incentives than the MIPS track, but require more advanced levels of value-based activities. APMs also require physicians to be part of a larger group, such as an accountable care organization (ACO) or medical home, and to bear greater financial risk.
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Topics: MIPS, APMs, MACRA

The medical home model: What physicians need to know

Posted by Continuum on Nov 1, 2016 1:08:19 PM

The concept of a “medical home” has evolved over the years, starting in the 1960s as the center of medical records for a child with special healthcare needs. Today, that definition is greatly expanded: A medical home is a partnership between the patient, family and primary care provider, in cooperation with specialists and community supports, according to the U.S. Department of Health and Human Services. It can encompass children and adults, regardless of their healthcare needs.

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Topics: Value-Based Healthcare, MIPS, APMs

Medicare Quality Data: Who Must Report?

Posted by Continuum on Aug 16, 2016 11:00:00 AM

Starting next year, most doctors will be required to report quality data under Medicare’s new Merit-Based Incentive Payment System (MIPS). MIPS will apply to other clinicians, too, such as physician assistants and nurse practitioners. However, many thousands of practitioners will be exempt from these requirements, if they meet certain criteria.

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Topics: value-based reimbursement, MIPS, APMs, Alternative Payment Models

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