The idea of converting my practice into a patient-centered medical home (PCMH) came into focus as we, like many, struggled with flattening reimbursements, limited time with patients, and a payment system that rewards volume rather than value. We’ve embraced PCMH not just as a stepping stone towards payment transformation but as a noble recasting of our essential care delivery model.
PCMH is what healthcare “done right” looks like. By taking responsibility for patients’ outcomes, these practices testify to the power of even the smallest practices to gradually bring about great change. More and more, financial incentives are being offered to those practices that have risen to the challenge, rewarding them for the value they create.
There are other ways to experiment with quality outcomes and rewards, but none that strike at the heart of a doctor’s vocation in quite the same way. Unlike accountable care organizations and shared savings programs, which were designed expressly as alternative payment models, PCMH was invented as an alternative care model. Its requirements tap into performance and outcomes, but also a practice’s ability to manage, coordinate, and support the basic pillars of health.
Restructuring a practice into a PCMH is a big task requiring the reorganization of some of its most basic organization. How do you get providers thinking in terms of teamwork, to focus on outcomes, and to do it in a financially accountable manner? One overlooked question, but arguably one of the most important, is: How will your health information technology (IT) services support you?
PCMH requirements are inherently IT-oriented, from the way an encounter is documented to how that patient can access it electronically. But this is a shallow approximation of the full value health IT can offer to aspiring PCMHs.
Intelligent, cloud-based IT supports communication, clinical decision-making and patient engagement. Many other features of a PCMH, such as coordination and collaboration, are outlined in my practice’s cloud-based EHR, whose workflows are pre-validated by the NCQA to help us capture points towards formal recognition. Simply click a button, and our EHR prints out reports we can use to apply.
Many practices have already invested in their EHRs because of the meaningful use program. Engaging in the PCMH recognition process is a critical occasion for physicians to reconsider how-and if-the IT tools they’re using are backed by the services necessary to help them thrive through industry change.
At my practice, PCMH recognition has been powerful for our patients, who express record levels of satisfaction and demonstrable improvements in outcomes. Others along the care continuum are taking notice and rewarding us for our efforts. Many private payers are contributing $2 to $3 dollars on a per member/per month basis for recognized practices. Beginning in 2018, Medicare will reward them with a 5% reimbursement bonus.
At its heart, PCMH is a care model delivering on the core aims of primary care. It is a way to earn additional revenue while making a change for the better to help doctors do what they were trained to do: Create value for patients.
Chris Apostol, MD, is a family physician with the Evans Medical Group in Evans, Georgia. Send your practice management questions to firstname.lastname@example.org.