YouTube and PCMH

For additional information and perspectives on the Patient-Centered medical Home, check out the MedicalHome4All Channel on YouTube.  Click the image below or on MedicalHome4All to be directed to the site.

A Merk presentation on Patient-Centered Medical Home.  Click to view.

PCMH Consultations

CIPA would like to inform you of a new program focusing on Patient-Centered Medical Homes (PCMH) developed by Blue Cross Blue Shield of Michigan (BCBSM). PCMH is a transformational change in the way physicians practice medicine. It represents a pro-active approach to guiding patients as they take a more active role in managing their own health and medical conditions. Once certified, your practice can receive increased reimbursement for Evaluation and Management services of at least ten percent.

This program is an on-going initiative developed by BCBSM to improve the quality of patient care. The program requires each practice to go through a recertification process annually. Each year as the program advances, the certification criteria will also become more advanced. The first round of nominations has already occurred, but look for other opportunities to nominate your office in the future. If you are in CIPA, follow the criteria within the Physician Group Incentive Program (PGIP) to reach nomination. There will also be an opportunity for advanced certification in subsequent years, which will result in greater BCBSM reimbursement.

 

During the nomination and certification process, CIPA will send a consultant and clinical integration team out to your practice to help assess your practice and develop an action plan for implementing PCMH criteria.  We will provide you with tools, sample policies, handouts, and helpful information to get your practice on its way to becoming a PCMH.

 

What is a Patient-Centered Medical Home?

There is a lot of buzz about the Patient-Centered Medical Home.  What is it and what does it mean for your practice?  The discussion is confusing with all the jargon and value-laden descriptions.  There are dozens of professional societies, business coalitions, consulting firms,accreditation agencies, governments and insurance companies that all have a little different perspective on the Patient-Centered Medical Home.

CIPA summarizes all that discussion this way:  The Patient-Centered Medical Home is the ideal physician practice for primary care, especially preventive care and the management of chronic disease.  The Patient-Centered Medical Home is about strong patient-physician relationships, engaged patients, new access to the physician, simple computer technology to track patient care against evidence-based standards and supportive teams that help educate patients about their disease and stay committed to their care plan. The focus of the Patient-Centered Medical Home is managing care, inside the office and out.

This focus starts with the patient-physician relationship.  It must be strong.  The patient must know who his physician is and he must be able to see that physician when he think she needs to.  The physician must be committed to treating the whole patient by coordinating other physicians, hospitals, ancillary providers, social service agencies and the family.  The patient must be informed about and actively engaged in his care.  The physician must help him get informed and be engaged.

We cannot expect physicians to do all that on their own.  They need help.  This comes from advanced practice nurses and diabetic educators working in the physician’s office to coordinate patient education and after hours care.  It comes from accessible, problem-focused computer technologies like patient registries and e-prescribing.

It is best not think of the Patient-Centered Medical Home as a single, exact way of doing things.  Instead, look at all the ideas about the Patient-Centered Medical Home, pick one that makes sense to you, work with your staff to design a plan to implement that idea in your practice right now,measure your success over time and revise your plan to improve your success.  When you get that idea nailed down (almost), pick a new idea and start over.

The Patient-Centered Medical Home requires measuring your performance and working to continuously improve.  In the end, you will feel better about the care you provide your patients and the success of your practice, but to quote Colonel Green from The Bridge on the River Kwai, “In a job like yours, even when it's finished, there's always one more thing to do.”

The more you read about the Patient-Centered Medical Home, the more realize there isn’t that much about it that is new or surprising.  It all makes sense intuitively.  It is a nice packaging of ideas that you have heard before, ideas that you would like to implement in your practice, ideas that somebody needs to pay for.

The Patient-Centered Medical Home requires a new way to pay for physician services.  In addition to fee-for-service payments, there needs to be monthly care management fees and incentive payments for performance improvement.  If the Patient-Centered Medical Home is going to work for the people who pay the bills, it must reallocate expenditures between physicians and other parts of the health care system in order to cut overall medical expenditures.  The Patient-Centered Medical Home is important to all physicians, not just primary care physicians.  If paying for these improvements is reduced to a discussion about how to reallocate RVUs between physician specialties, they will not be implemented sufficiently to help primary care, specialists, hospitals, payers, or worst of all, patients.


What does a Patient-Centered Medical Home look like?

•   There is a written agreement between the physician and patient about how they are going to work together to implement a care plan.
•   The patient attends group visits where they get one-on-one time with their own physician (which is reimbursed) and time to talk to dieticians and other professionals about the details of their disease and their care plan.
•    Nurse practitioners and physician assistants are used to keep the practice open into the early evening and for half days on the weekend.
•    Almost all the time, the patient can get an appointment on the day they call.
•    The physician uses e-prescribing to maintain a comprehensive medication history and to generate error-free prescriptions.
•   The physician and his staff meet every day to review the plan for the patients scheduled for today, using the electronic patient registry to make sure they are on track.  Markers like which 50+ males need rectal cancer screening or which diabetics are due for a HbA1C test.
•   The MA enters all lab orders into the patient registry which reminds her when to check for results.  When she does enter them into the registry, it identifies which one she needs to talk to the physician about and which ones she can send to the patient with a secure email.
•   The physician has time during the day to review send a secure email to the orthopedic surgeon about the previous MRI on Mr. Jones’ knee and to reply to Mrs. Smith’s email about her new medication for her heartburn (and be reimbursed).