Aug 5, 2013 | Laboratory Hiring & Human Resources, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
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. (more…)
Dec 10, 2010 | Laboratory Management and Operations, Laboratory Pathology, Management & Operations
One Outcome is Fewer Hospital Inpatient Admissions, Resulting in Lower Costs and Increased Doctors’ Income
Early evidence indicates that
patient-centered medical homes (PCMH) may be great for patients and beneficial to primary-care physicians and insurers—but not as favorable for hospitals because of reduced inpatient admissions. The good news for
pathologist and
clinical laboratory is a medical home program appears to improve utilization of medical laboratory tests.
The basic idea behind the concept to the medical home is to centralize care around a
primary-care physician. This primary-care physician manages an integrated team of acute, chronic, preventative, and end-of-life specialists so as to provide patients with personalized care. Data from the first medical home pilot projects indicates that one outcome of a medical home programs is that fewer patients need hospital in-patient care.
(more…)
Apr 6, 2009 | Laboratory News, Laboratory Pathology
Meet the concept of the medical home. It is a managed-care delivery model that charges physicians with coordinating overall care for patients with chronic illnesses. Since its’ inception just a few years ago, it has spread nationwide. Medical home demonstration projects now operate in 22 states. Two states, Rhode Island and North Dakota, have implemented statewide programs.
By design, the medical home is a patient-centered, integrated care model. An important goal is to create a strong, long-term relationship between the physician and the patient. It does this by replacing episodic care based on illness with proactive, coordinated care provided by a physician-led team.
In 2008, the National Committee for Quality Assurance (NCQA) introduced standards to determine if a medical practice operates as a Patient-Centered Medical Home (PCMH). These standards meet the definition of a medical home as defined by a consortium that includes the American Academy of Pediatrics, American College of Physicians, American Academy of Family Physicians and American Osteopathic Association.
(more…)
Jan 7, 2009 | Laboratory News, Laboratory Pathology
Patient-Centered Medical Home (PCMH) is the latest concept in managed care. Primary care physicians, relegated to gatekeeper status in the HMO model of the 1990s, are elevated to the status of healthcare guru, taking the role of coordinating care, counseling, and educating patients. Launching the first statewide Patient-Centered Medical Home (PCMH), programs are Rhode Island and North Dakota.
The PCMH concept, which has been endorsed by the AMA, is a care delivery model that provides patients continuous access to a personal physician for the majority of their healthcare needs. There are 22 medical home pilots underway throughout the nation, but Rhode Island and North Dakota are first to take the concept statewide.
The leading advocate for the PCMH is the Patient Centered Primary Care Collaborative, a 200-member group that includes major employers, consumer groups, labor unions and healthcare providers and payers. It contends this healthcare model could improve the health of patients, while ensuring viability of the healthcare delivery system through reduced costs associated with shorter hospital stays, fewer hospital readmissions, and emergency department visits.
A statewide pilot of the Rhode Island Chronic Care Sustainability Initiative was launched last October on the heals of a 2004 state law mandating that health plans work to improve accountability in healthcare affordability, accessibility and quality. The pilot includes the state’s three biggest health plans, including the state’s Medicaid plan, Neighborhood Health Plan of Rhode Island’s Rhody Health Partners; Blue Cross and Blue Shield; and United Healthcare. These plans will pay the five participating primary care practices a fee of $3 per member, per month to cover the services of a care-management nurse.
Rhode Island insurers are optimistic about the model’s potential for reducing healthcare costs and improving outcomes. They also suggest that the new care model, which provides compensation for extra time spent caring for patients, will improve physician satisfaction. Not only with this be due to increased reimbursement, but also because the physicians will have the ability to provide consistent care across the board, regardless of the patient’s health plan.
North Dakota has already completed a two-year pilot of its MediQHome Quality Project, a PCMH pilot focused on diabetes care. The pilot demonstrated an estimated $102,000 savings in the care provided to 192 diabetes patients. The state launched its full-fledged, statewide PCMH program on January 1, 2009.
Under the North Dakota program, Blue Cross Blue Shield of North Dakota, the state’s largest health plan, has agreed to pay primary care physicians a semiannual $50 care-management fee for Blues members treated for coronary artery disease, diabetes or hypertension. However, according to a report from Modern Healthcare, Jon Rice, North Dakota Blues CEO/senior vice president, questions the need for a “medical home infrastructure” to achieve better outcomes and cost savings. He points out that the pilot focused on a single health issue, but has yet to prove its mettle as a broad-based quality improvement program.
This mirrors the position of TransforMed, a nonprofit subsidiary of the American Academy of Family Physicians that is concerned with creating a financially sustainable healthcare model through a nationwide medical home system. TransforMed urges that an effective medical home program must address all patients in a primary care practice, not just certain diseases.
If there is a downside to the medical home trend, it is that it adds to the workload for doctors, even as the pool of primary care physicians dwindles. Practicing primary care physicians are leaving the field to enter higher-paying specialties. Fewer medical school students are opting to enter primary care.
Dark Daily expects that one consequence of the medical home movement will be for physicians to shift their lab test utilization patterns toward greater use of predictive testing and risk assessment testing. That’s because a major goal of the medical home arrangement is to encourage early diagnosis and active intervention to help the patient maintain optimal health.
Related Information:
The Dangers of the Decrease In Primary Care Physicians
