In the Journals

Centralized patient-centered medical home may reduce burden on practices

Although centralized patient-centered medical homes reduce burden on practices, overall time and cost remain significant and should be weighed against the mixed evidence regarding their impact on quality and costs of care, according to research published in the Journal of the American Board of Family Medicine.

“Evidence regarding the impact of the [patient-centered medical home (PCMH)] model on quality of care, health resource utilization, and outcomes has been gradually accumulating. However, little information is available regarding the time, effort, and costs involved,” Neil S. Fleming, MD, Robbins Institute for Health Policy and Leadership, Baylor University, and colleagues wrote.

“Such information is critical to primary care providers engaged in decisions about whether (or when) to commit to PCMH transformation so that they can anticipate the demands and allocate resources accordingly in order to ensure minimal disruption of patient care and the practice's financial health,” they added.

Fleming and colleagues noted that many primary care physicians may need to reconsider the PCMH option when the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015 comes into effect this year, as PCMH recognition from a national third-party program is an avenue that guarantees physicians following the Merit-Based Incentive Payment System pathway full credit in the Clinical Improvement Activities portion of the Merit-Based Incentive Payment System score.

Researchers performed structured interviews with corporate leaders, office managers, physicians and practice administrators from a conventional sample of practices regarding time spent on PCMH transformation and National Committee for Quality Assurance application, and related purchases between October 2014 and October 2015. According to Fleming and colleagues, the time period was chosen to capture both initial PCMH transformation and renewal experiences.

Researchers then developed and sent a survey to 57 primary care practices across Texas that consisted of four blocks of questions. This allowed for the fact that some respondents were not involved in PCMH transformation and renewal experiences, recognition or recertification at all, whereas others participated in one or the other or both. Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures.

Researchers estimated that corporate costs for HealthTexas — a fee-for-service ambulatory care provider network affiliated with a not-for-profit health care system in north and central Texas —for initial National Committee for Quality Assurance recognition (2010–2012) were $1,508,503. The estimated costs for renewal (2014–2016) were $346,617. The Care Coordination resource costs were an additional ongoing $390,790 per year. A theoretical five-physician HealthTexas practice spent an estimated 239.5 hours ($10,669) obtaining, and 110.5 hours ($4,957) renewing, recognition.

“Because no previous studies have, to our knowledge, examined PCMH transformation and [National Committee for Quality Assurance] recognition in a large physician network providing central support for the process, comparison of our results with those in the literature is difficult,” Fleming and colleagues wrote.

The researchers added that future studies should address the extent to which practices were “transformed” through the PCMH recognition process, as well as whether attaining PCMH recognition is a truly a representation of the PCMH model being meaningfully implemented. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

Although centralized patient-centered medical homes reduce burden on practices, overall time and cost remain significant and should be weighed against the mixed evidence regarding their impact on quality and costs of care, according to research published in the Journal of the American Board of Family Medicine.

“Evidence regarding the impact of the [patient-centered medical home (PCMH)] model on quality of care, health resource utilization, and outcomes has been gradually accumulating. However, little information is available regarding the time, effort, and costs involved,” Neil S. Fleming, MD, Robbins Institute for Health Policy and Leadership, Baylor University, and colleagues wrote.

“Such information is critical to primary care providers engaged in decisions about whether (or when) to commit to PCMH transformation so that they can anticipate the demands and allocate resources accordingly in order to ensure minimal disruption of patient care and the practice's financial health,” they added.

Fleming and colleagues noted that many primary care physicians may need to reconsider the PCMH option when the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015 comes into effect this year, as PCMH recognition from a national third-party program is an avenue that guarantees physicians following the Merit-Based Incentive Payment System pathway full credit in the Clinical Improvement Activities portion of the Merit-Based Incentive Payment System score.

Researchers performed structured interviews with corporate leaders, office managers, physicians and practice administrators from a conventional sample of practices regarding time spent on PCMH transformation and National Committee for Quality Assurance application, and related purchases between October 2014 and October 2015. According to Fleming and colleagues, the time period was chosen to capture both initial PCMH transformation and renewal experiences.

Researchers then developed and sent a survey to 57 primary care practices across Texas that consisted of four blocks of questions. This allowed for the fact that some respondents were not involved in PCMH transformation and renewal experiences, recognition or recertification at all, whereas others participated in one or the other or both. Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures.

Researchers estimated that corporate costs for HealthTexas — a fee-for-service ambulatory care provider network affiliated with a not-for-profit health care system in north and central Texas —for initial National Committee for Quality Assurance recognition (2010–2012) were $1,508,503. The estimated costs for renewal (2014–2016) were $346,617. The Care Coordination resource costs were an additional ongoing $390,790 per year. A theoretical five-physician HealthTexas practice spent an estimated 239.5 hours ($10,669) obtaining, and 110.5 hours ($4,957) renewing, recognition.

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“Because no previous studies have, to our knowledge, examined PCMH transformation and [National Committee for Quality Assurance] recognition in a large physician network providing central support for the process, comparison of our results with those in the literature is difficult,” Fleming and colleagues wrote.

The researchers added that future studies should address the extent to which practices were “transformed” through the PCMH recognition process, as well as whether attaining PCMH recognition is a truly a representation of the PCMH model being meaningfully implemented. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.