Value-based reimbursement will largely be the new law of the land as the Senate stepped up to pass the Medicare Sustainable Growth Rate (SGR) repeal. Thankfully, the repeal helped physicians avoid a 21% Medicare payment cut as well as moved the value-based reimbursement forward. The threat of deep cuts to fee-for-service Medicare payments having been eliminated, providers are now expected to participate in the unified Merit-Based Incentive Payment System (MIPS). Quality reporting (PQRS) and Value Based Modifier (VBM) programs allowing providers to attest only once on clinical quality measures (CQM???).
The healthcare industry had an anxious period during its spring recess, but finally the Senate joined the House in approving the legislation by an overwhelming 92-8 vote. This brought an era of definite uncertainty for Medicare holders and their providers and will create more innovation in care models that will lower costs and still work on quality care issues.
They will also be able to obtain financial bonuses by participating in innovative care delivery models like the patient-centered medical home (PCMH). The expectation through reformation of health care delivery is to promote population health management with better care coordination, and increased use of health information exchanges together with clinical analytics for patient risk stratification and more comprehensive preventive care. The SGR repeal allows for a five percent bonus for those providers who will accrue at least a quarter of their Medicare revenue through alternative care models and value-based reimbursement arrangements by 2018.
The Agency for Healthcare Research and Quality (AHRQ) recognizes that revitalizing the Nation’s primary care system is foundational to achieving high-quality, accessible, efficient health care for all Americans. The primary care medical home, also referred to as the patient centered medical home (PCMH), advanced primary care, and the healthcare home, is a promising model for transforming the organization and delivery of primary care. This web site provides policymakers and researchers with access to evidence-based resources about the medical home and its potential to transform primary care and improve the quality, safety, efficiency, and effectiveness of U.S. health care.
The medical home encompasses five functions and attributes:
1. Comprehensive Care
The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators. Although some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities.
The primary care medical home provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.
3. Coordinated Care
The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.
4. Accessible Services
The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care. The medical home practice is responsive to patients’ preferences regarding access.
5. Quality and Safety
The primary care medical home demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.
Read all about PCMH and sign up for the webinars at:
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