Practice Strategies

Offering Patients a Medical Home

The concept of patient-centered care is hardly new, but primary care physicians often struggle to provide comprehensive, accessible, and coordinated health care services to patients while still covering their own expenses. Contending that traditional health care delivery models are increasingly ineffective at controlling costs and ensuring quality care to patients over the long term, several influential physicians’ associations and the federal government are calling for a new approach to the delivery and reimbursement of primary care known as the medical home.

In practices that have adopted a medical home model, patients are encouraged to develop a personal relationship with their primary care physician, who provides them with not only routine preventive care and treatment for acute illnesses, but also advice and assistance in maintaining a healthy lifestyle and obtaining needed services from other health care providers and the community.

Many primary care practices in the U.S. are already following the principles of the medical home concept, but without adequate reimbursement for their efforts. Physicians concerned about the well-being of their patients frequently perform services outside the bounds of the traditional office visit, such as making referrals, communicating with patients by phone or email, contacting pharmacies, or arranging additional health care services on behalf of individual patients. But taking on these responsibilities on top of their already substantial clinical and administrative duties can become a drain on the resources of primary care providers.

To make adopting this holistic approach to practicing medicine a realistic option for physicians, several initiatives are testing the effectiveness of different methodologies and technologies that may prove useful in implementing the medical home model. In June 2006, TransforMed, a not-for-profit practice redesign initiative of the American Academy of Family Physicians (AAFP), launched the National Demonstration Project (NDP), a two-year patient-centered care pilot project involving 36 family practices from across the United States. Researchers expect that evaluation and analysis of the results of this project will lead to the development of processes and tools that can be used by any family practice interested in trying this approach.

The goals of the NDP project are wide-ranging: Physicians are expected to create a personal medical home for each patient that ensures access to comprehensive and integrated care, while patients are encouraged to become active participants in their care. The project also demands that practices develop a multidisciplinary team approach to delivering care and directs practices to remove barriers of access through open scheduling, expanded office hours, and additional means of communication between patients and practice staff. To achieve these goals, organizers recommend that practices implement an IT system that includes electronic health records (EHRs) and other online tools to facilitate monitoring and scheduling, including patient registries and secure email systems.

The federal government is also investigating ways to improve the provision of primary care services. The Tax Relief and Health Care Act of 2006 created the Medicare Medical Home Demonstration (MMHD), a three-year medical home pilot program tentatively scheduled to begin in September 2008. While the project is still under development, the MMHD is currently set to involve primary care physicians in urban, rural, and underserved areas in up to eight states.

According to the Centers for Medicare and Medicaid Services (CMS), the MMHD will pay care management fees to personal physicians implementing a care plan and coordinating services for high-need Medicare beneficiaries with multiple chronic conditions or prolonged illnesses, and it will offer incentive payments to participating physicians. In particular, the CMS said, physicians taking part in the demonstration will be rewarded for providing care that is evidence-based and clinically appropriate, and for using clinical decision support tools, health assessments, and health IT systems.

These and other projects will help determine whether the medical home model is more useful than traditional forms of primary care delivery in meeting the ongoing health care needs of patients through enhanced disease management and preventive care, while also lowering expenses for insurers, patients, and providers. The widespread adoption of the medical home approach could produce fundamental changes in the way primary care physicians are reimbursed, with remuneration reflecting not just the volume of medical services provided, but also the full range of patient-centered activities family physicians perform every day.

For more information about our services to the healthcare industry, contact:
Maxine Lawyer, CPA, Partner - Dallas/Fort Worth at 972.448.6905 or
Philip Fox, CPA, Partner - Houston at 713.297.6914.

The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
© 2007