The House Healthcare Reform Bill – How Will Primary Care and the PCMH be Affected?
PCMH appears to have a home, but when should the studying end and the doing begin?
By Jay I. Pomerantz, MD – Senior Physician Advisor for Health Integrated
Wow – I just downloaded the House’s version of the healthcare bill – titled, H.R. 3962[1], with the subtitle, “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” As you might have heard, it is 1990 pages in length. With politics aside, I have had an opportunity to go through the bill with an eye on what it means for primary care and in particular, patient-centered medical homes. There are many references to both which I would like to review.
As I carefully read the bill, there are 52 references to the medical home, beginning on page 219. There are additional sections that just deal with primary care aside from PCMH – they are numerous, and for the sake of focus, I’ll concentrate on PCMH and related topics for this posting.
The first reference to PMCH is under section 324, Modernized Payment Initiatives and Delivery System Reform, where ‘innovative payment mechanisms’ like PCMH are reviewed. The bill continues with detailed explanations outlining the criteria and logistics of “Establishment of a Pilot Program for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes [PCMH] for furnishing medical home services…” This pilot detail includes:
- Evaluation of several models – Independent PCMH and Community-based PCMH
- Guidelines for the allowance of nurse practitioners to lead PCMHs
- Definition of PCMH services
- Definition of Primary Care
- Definition of ‘beneficiaries’
- Definitions of Independent and Community-based PCMHs
- Payment authority
- These pilot programs will last no more than 5 years…
5 years?
There’s an old saying about snakes. “If you see a snake, just kill it – don’t appoint a committee on snakes.” If you read the HR3962, you will see how the analogy applies.
The concept of PCMH was defined by very well-informed groups in 2006, including the ACP, AAFP, AAP and AOA, and further approved by another impressive list of professional organizations in February of this year[2]. It seems to me that there is already a significant body of fact-based data collected from multiple medical home implementations such that we should be looking more at execution than at enacting additional studies. We have shared in previous postings, as have other authors in countless blogs and news reports, the successful implementation of PCMHs within such health plans as Geisinger, Community Care (NC), the Southeastern Pennsylvania Project, North Dakota Blue Cross/Blue Shield[3], Group Health[4] and others. All have shown the significant results of successful PCMH implementation. Interestingly, most of the issues to be studied in the proposed pilot program from HR3962 have already been tried, modified, tested, documented and shared within the healthcare community, hence the ongoing success of many of these PCMH programs.
In addition to the ongoing PCMH demonstrations, the NCQA PPC®-PCMHTM program (which reflects the input from the organizations listed above), assesses, scores and certifies that practices are indeed operating as functional medical homes. This program has been ongoing for several years. My belief is that these standards combined with examples of successful implementations should serve as the guide for additional PCMH implementation. Why is it then that we should spend additional tax money, exert the extra effort and lose valuable time in further pilot program studies versus focusing on expanding PCMH implementation?
Much of the healthcare reform bill further studies ‘payment authority’, and details layers of criteria to qualify or not, the activities within the PCMH. With examples of successful programs like those listed above, oversight from NCQA certification, and outcome data highlighting better patient healthcare and dramatic cost savings, it seems to me that these programs are somewhat self-funding. If you accept this premise, why then should we spend more money to further study the PCMH through another pilot program? Adding yet another layer of confusion is the recent announcement by HHS Secretary Sebelius, who was joined by the Director of the White House Office of Health Reform and the Governor of Vermont, the establishment of the Advanced Primary Care model (APC) demonstration project[5] to begin in 2010. The APC is a PCMH by another name. There seems to be overlapping and redundant programs being planned and funded to determine outcomes that have already been proven. I know I sound like a skipping CD, but why are additional pilot programs being funded and studied once again?
In tracking the kinetics of the market, published data identifies close to one-third[6] of health plans currently offer a PCMH (most of which are not yet full scale though). The news for the remaining health plans is also encouraging. From our previous posts and available market research among current health plans, almost half of those remaining health plans are planning on implementing a PCMH within the next 12 months. It is clear to me that PCMHs have momentum, significant interest from the healthcare and physician community, and proven efficacy. So I ask again, why do we have to further study PCMHs? They work. The concept has been proven in practice. We need more doing and a little less spending of valuable time and resources on further studying what has already been studied and concluded.
I can tell you this – if I see a snake, believe me when I say that I will not study it! I have attached the bill for your perusal. What do you think?
Thank you for reading. I encourage your commentary and forwarding. You are welcome to contact me directly at pcmhdialog@healthintegrated.com. As always, I have listed some future topics in which I would welcome your review and comments.
Best Regards,
Jay I. Pomerantz, MD
Upcoming topics for the Health Integrated PCMH Collaborative Community
- Healthcare reform and the PCMH – the continuing review and update
- Examples of ongoing PCMHs
- PCMH and healthcare disparities
- Expert opinions on the healthcare reform and PCMH
- Expense consolidation for the PCMH
- Standards for PCMH pilots and programs – how to establish a program
- Others?
Notes:
1. Download: House Healthcare Reform Bill
[1] http://docs.house.gov/rules/health/111_ahcaa.pdf
[2] http://www.wvdiabetes.org/Portals/12/Medical%20Home%20and%20NCQA%20Standards%20%282009-06-24%29.pdf
[3] http://blog.healthintegrated.com/?p=80
[4] http://blog.healthintegrated.com/?p=244 – Group Health Cooperative
[5] http://www.healthreform.gov/newsroom/factsheet/medicalhomes.html
[6] Medical Home Models: Improving Care and Reducing Costs in Healthcare. HIN, 5/09
