Is It Worth It to Become a Patient-Centered Medical Home?

Anne L. Finger, MA


October 22, 2013

In This Article

Practice Better Medicine and Get Rewarded for It

The patient-centered medical home (PCMH) is rapidly gaining popularity as a way to make primary care more accessible, comprehensive, and coordinated; to improve patient outcomes; and to lower overall healthcare costs. Since 2008, when the National Committee on Quality Assurance (NCQA) began recognizing practices as a PCMH, more than 26,000 clinicians at more than 5000 practice sites have received the NCQA designation, and the numbers are rising steadily.

Done right, not only do PCMHs enable physicians to practice better medicine, but they may even give a jump start to a practice's bottom line, in ways we'll describe later on.

The PCMH is based on a team approach that may include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, and social workers and coordinate with hospital, home healthcare, and community services.

While the jury is still out on the extent of improvements the PCMH model will offer in helping patients gain access to primary care, many experts, including growing numbers of payers, are convinced of its value.

But the process of gaining PCMH designation from the NCQA, the leading standard-setting organization, is unwieldy and time-consuming. So it's reasonable for clinicians to do a cost-benefit analysis before deciding whether to embark on the PCMH journey.

How Do You Earn a PCMH Designation?

There are 3 levels of NCQA recognition, ranging from Level 1 to Level 3, the highest. Getting there involves meeting requisite elements in 6 "Standard" categories: Enhance Access and Continuity; Identify and Manage Patient Populations; Plan and Manage Care; Provide Self-Care Support and Community Resources; Track and Coordinate Care; and Measure and Improve Performance.

In each of those categories, there is one "must-pass element," such as access during office hours, referral tracking, and follow-up. "The effort involves changing processes in a practice to be more patient-centered," says Susanne Madden, CEO of The Verden Group, a practice management consulting firm in Nyack, New York. "Do patients need glucose testing training? Are you tracking imaging, testing, referrals, labs, helping make appointments with specialists -- generally closing the loop?"

The good news is that many clinicians are doing many of these things already; the less-good news is that they're now required to document them all.

"I have not seen anyone object to what's required," says Margalit Gur-Alie, a founder of BizMed, a company in St. Louis, Missouri, that guides clinicians through the process. "It's not the substance that's the problem; it's the form."

For example, Gur-Alie points out in an article she wrote for the journal HIT Consultant that the NCQA Standard to identify and manage patient populations simply requires that you document patient demographics and clinical information in the chart, take good histories, and send your patients reminders about their chronic and/or preventive care needs.

One difference: The Standard requires that proactive reminders be sent to patients who don't come in when they should. "Good for business and definitely good for patient care on an individual level," she writes.[1] But collecting all the data to qualify, she notes, is a "humongous administrative effort."

The first category, Enhance Access and Continuity, requires accessibility both during and after hours, which may require a solo practitioner to do some practice re-engineering, possibly arranging some evening or weekend hours.

For Glenda Richardson, MD, a pediatrician in Kenner, Louisiana, who gained Level 1 designation, the need for after-hours accessibility wasn't a problem. "I've been available 24/7 every year of my practicing life," she says. "I don't go on many vacations, and I have a contract with 2 friends who cover when I'm away."

However, the process showed her that her scheduling system was resulting in backups during office hours that were leading to patient complaints. "We had to do a log on all calls for a week and count them up -- why patients were coming in, how long it took. I now leave a few more spots for walk-ins, and that gives me more time for my patients," Richardson says.

For a detailed look at what's required, visit the NCQA Website.


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