While accountable care organizations have sparked a considerable amount of debate and scrutiny in the past year, patient-centered medical homes are beginning to establish a more secure and prominent position in the healthcare industry. Unlike ACOs, there is not yet an accrediting organization for PCMHs, but NCQA is currently the largest organization to offer recognition for becoming a PCMH based on a list of standards, application and fee. The model is largely voluntary, but recognized PCMHs can still receive payment from hospitals, health systems and payors that is specifically and individually negotiated.
PCMHs can offer rich benefits not only to patients, but to physicians and hospitals as well — particularly if hospitals already own primary care practices. Here, Melissa Gerdes, MD, chief medical officer of outpatient services and ACO strategy for Methodist Health System in Dallas, discusses some of the rewards healthcare systems can garner through PCMHs.
1. Patients receive care at a lower cost. Patient co-payments are generally less expensive in a PCMH, and through increased care coordination, patients are able to receive more care in a single visit to their primary care provider. For example, if a patient has a rash, needs preventive care and has a question about their sleeping habits, they can be treated by their primary care physician for a flat co-payment 90 percent of the time.
"Usually, if you had to take care of these individual problems, you would make co-payments for each one and each specialist — a dermatologist, a gynecologist and your primary care physician," says Dr. Gerdes. "PCMHs are coordinated, so all the pieces are in one place."
On a larger scale, there are added savings through the economies of physicians and medical offices knowing their patients better. Physicians and providers will have a firmer understanding of your medications, what treatment has proven most effective and what tests have already been performed. This reduces the amount of duplicate or unnecessary care that is so often blamed for America's soaring healthcare costs.
2. The model is naturally physician-led. With numerous components such as payors, physicians, nursing homes and hospitals, ACOs are not designed to be inherently physician led like PCMHs are. "I think PCMHs are more physician-led from conception, where ACOs are distributed among all parts of the healthcare system," says Dr. Gerdes.
3. It can alleviate primary care physician shortages. The national shortage of primary care physicians is really hitting certain local markets especially hard. While not a solution to the problem, a PCMH can certainly alleviate this strain. With a team-approach to healthcare, physician extenders, mid-level providers and other medical specialists in the PCMH can deliver pieces of the care continuum as medically appropriate. PCMHs can also serve as a recruitment tool for hospitals, since many primary care physicians are attracted to the model, according to Dr. Gerdes.
4. It can reduce hospital readmissions and length of stay. The PCMH model makes even more sense as hospitals hone their focus on reducing readmissions. "If a patient belongs to a PCMH and he/she gets admitted to the hospital, that PCMH will actively seek and find them to bring them back into the medical home and work to prevent avoidable readmissions to the hospital," says Dr. Gerdes. This proactive approach to follow-up care is valuable given how many individuals struggle with post-discharge medications, dietary plans and other treatment requirements, often ending up in hospital emergency departments.
Along with reduced readmissions, PCMHs can help hospitals make the patients' length-of-stay more efficient. "If a physician has a [known high-quality] place to send patients upon discharge, the patient may be discharged when it is medically appropriate," says Dr. Gerdes. "This might cut half a day or a day off discharge time, which is a big [source of] savings to hospitals," says Dr. Gerdes.
5. It can enhance physician and employee satisfaction. When Methodist CEO Steven Mansfield came to the system in 2006, he wanted to focus on the health of Methodist employees. A pilot PCMH implemented at 11 of the system's family health centers helps coordinate care for a group of employees with chronic illnesses. "They see their primary care physician more, receive personalized care plans and develop three healthy goals they'll commit to every three months," says Dr. Gerdes. Employees also receive monetary rewards to offset the costs of wellness initiatives, such memberships to gyms or Weight Watchers, and Dr. Gerdes says participating employees have expressed satisfaction with the initiative.
Aside from an employee wellness pilot, PCMHs can lead to more satisfied physicians. Many providers cite administrative burdens as detractors from their profession, while patient care continues to be the part they find most rewarding. PCMHs enable physicians to involve patients and their family members in shared decision-making. They can also foster stronger and closer relationships between patients and physicians.
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PCMHs can offer rich benefits not only to patients, but to physicians and hospitals as well — particularly if hospitals already own primary care practices. Here, Melissa Gerdes, MD, chief medical officer of outpatient services and ACO strategy for Methodist Health System in Dallas, discusses some of the rewards healthcare systems can garner through PCMHs.
1. Patients receive care at a lower cost. Patient co-payments are generally less expensive in a PCMH, and through increased care coordination, patients are able to receive more care in a single visit to their primary care provider. For example, if a patient has a rash, needs preventive care and has a question about their sleeping habits, they can be treated by their primary care physician for a flat co-payment 90 percent of the time.
"Usually, if you had to take care of these individual problems, you would make co-payments for each one and each specialist — a dermatologist, a gynecologist and your primary care physician," says Dr. Gerdes. "PCMHs are coordinated, so all the pieces are in one place."
On a larger scale, there are added savings through the economies of physicians and medical offices knowing their patients better. Physicians and providers will have a firmer understanding of your medications, what treatment has proven most effective and what tests have already been performed. This reduces the amount of duplicate or unnecessary care that is so often blamed for America's soaring healthcare costs.
2. The model is naturally physician-led. With numerous components such as payors, physicians, nursing homes and hospitals, ACOs are not designed to be inherently physician led like PCMHs are. "I think PCMHs are more physician-led from conception, where ACOs are distributed among all parts of the healthcare system," says Dr. Gerdes.
3. It can alleviate primary care physician shortages. The national shortage of primary care physicians is really hitting certain local markets especially hard. While not a solution to the problem, a PCMH can certainly alleviate this strain. With a team-approach to healthcare, physician extenders, mid-level providers and other medical specialists in the PCMH can deliver pieces of the care continuum as medically appropriate. PCMHs can also serve as a recruitment tool for hospitals, since many primary care physicians are attracted to the model, according to Dr. Gerdes.
4. It can reduce hospital readmissions and length of stay. The PCMH model makes even more sense as hospitals hone their focus on reducing readmissions. "If a patient belongs to a PCMH and he/she gets admitted to the hospital, that PCMH will actively seek and find them to bring them back into the medical home and work to prevent avoidable readmissions to the hospital," says Dr. Gerdes. This proactive approach to follow-up care is valuable given how many individuals struggle with post-discharge medications, dietary plans and other treatment requirements, often ending up in hospital emergency departments.
Along with reduced readmissions, PCMHs can help hospitals make the patients' length-of-stay more efficient. "If a physician has a [known high-quality] place to send patients upon discharge, the patient may be discharged when it is medically appropriate," says Dr. Gerdes. "This might cut half a day or a day off discharge time, which is a big [source of] savings to hospitals," says Dr. Gerdes.
5. It can enhance physician and employee satisfaction. When Methodist CEO Steven Mansfield came to the system in 2006, he wanted to focus on the health of Methodist employees. A pilot PCMH implemented at 11 of the system's family health centers helps coordinate care for a group of employees with chronic illnesses. "They see their primary care physician more, receive personalized care plans and develop three healthy goals they'll commit to every three months," says Dr. Gerdes. Employees also receive monetary rewards to offset the costs of wellness initiatives, such memberships to gyms or Weight Watchers, and Dr. Gerdes says participating employees have expressed satisfaction with the initiative.
Aside from an employee wellness pilot, PCMHs can lead to more satisfied physicians. Many providers cite administrative burdens as detractors from their profession, while patient care continues to be the part they find most rewarding. PCMHs enable physicians to involve patients and their family members in shared decision-making. They can also foster stronger and closer relationships between patients and physicians.
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