The Increase in Certifications is the Result of New Reimbursement Models for Patient-Centered Medical Homes by Third-Party Payers
There is much activity in the patient-centered medical homes (PCMH) sector of the U.S. healthcare system. A host of certification and accreditation bodies have set up shop and they report a rapid increase in the number of organizations they are recognizing as medical homes.
That fact alone is significant news. It is evidence that physicians are spending substantial time and money to convert their medical practices into medical homes. In turn, this trend represents an opportunity for clinical laboratories and anatomic pathology groups, since medical homes need to order clinical laboratory tests on behalf of their patients.
Medical Home Certifications Grow with Increasing Demand
Along with the fact that a number of credible organizations have initiated certification and accreditation programs for PCMHs, there is the growing number of health insurers who are willing to reimburse medical homes using different models of reimbursement. This is additional credible evidence that the medical homes movement is setting down deep roots.
It was February of this year when The Joint Commission issued a press release announcing its new program to certify medical homes on behalf of hospitals and critical access hospitals. This expanded The Joint Commission’s PCMH certification program, which was originally established in 2011 as a service for accredited ambulatory care organizations.
The Joint Commission has certified 47 medical home practices since establishing this program, noted Lon Berkeley, co-project leader for this certification program.
NCQA Is Big Player in Medical Home Certification
Meanwhile, the National Committee for Quality Assurance (NCQA) may be the biggest player in the medical home certification market. It has declared that its new medical home expert-certification program was an instant success, noted Modern Healthcare. Since mid-2008, the NCQA has recognized 5,200 practices as medical homes.
Upon launching its medical home content expert certification service earlier this year, NCQA has received 1,500 requests for the program handbook, according to Patricia Barrett, Vice President of NCQA Product Development. Additionally, medical home training programs held by NCQA last January and March in New Orleans and Orlando sold out, with 200 clinicians attending each one.
Demand by medical home organizations for accreditation and education services from the National Committee for Quality Assurance (NCQA) has increased steadily, according to Patricia Barrett, (pictured above). Barrett is the Vice President of NCQA Product Development and was quoted in Modern Healthcare. (Photo copyright NCQA.)
The NCQA followed this success with launch of a Patient-Centered Specialty Practice Recognition program. This initiative recognizes specialty practices that have successfully coordinated care with their primary care colleagues and each other. These practices must also meet the goals of providing timely access to care and continuous quality improvement.
Medical Homes Often Focus on Reducing Duplication of Med Lab Tests
Clinical laboratory managers and pathologists will be interested to learn that, among other things, the NCQA’s program is focused on reducing duplication of tests. It will also measure performance and encourage improved communication with patients, noted Barrett. She added that these medical practices should be working to reduce redundancy and the negative experience patients endure with poorly coordinated care.
The driver behind this activity, according to a Joint Commission press release, is an opportunity for providers operating as PCMHs to increase reimbursement from third-party payers.
Berkeley told Modern Healthcare that more than 100 medical home demonstration projects with third-party players are in progress.
“This is a major direction of the healthcare system,” he said, noting that feedback from hospitals already accredited indicates that the primary reason for securing this designation is to take advantage of new funding opportunities.
Recognizing these developments, the Joint Commission began offering to conduct surveys for medical home certification in conjunction with a hospital’s regular onsite certification process or separately, noted Berkeley. He said that The Joint Commission expects the number of hospital-based PCMH certifications will top 100 by yearend.
He also told Modern Healthcare that next year the Joint Commission will begin certifying “behavioral health homes” for behavioral health practices that also treat patients for physical health problems, such as diabetes, hypertension or injuries.
Growth of Medical Homes May Benefit Some Medical Laboratories
Along with accountable-care organizations, medical homes are expected to play a major role in healthcare reform. This development has some consequences. For example, improved patient health achieved by patient-centered medical homes may translate to fewer hospital inpatient admissions.
That means less medical laboratory test specimens for hospitals. However, PCMHs are likely to generate increased volumes of clinical laboratory testing as physicians more closely follow evidence-based medicine guidelines. Therefore, as long as clinical laboratories can negotiate adequate reimbursement for PCHMs, there may be new revenue opportunities from this new class of providers.
—By Patricia Kirk