ACP tells Congress: Pilot test patient-centered medical home

New model for financing and delivering care proposed by ACP president

(Washington) -- Medicare should pilot test a patient-centered medical home, Lynne Kirk, MD, FACP, president of the American College of Physicians (ACP), today told a hearing of the House Energy and Commerce Subcommittee on Health. She urged Congress to direct Medicare to institute the new model of financing and delivering care.

"The problem is Medicare payments do not support us as we try to organize our practices to help patients prevent complications that can lead to hospitalization," Dr. Kirk, a general internist and Associate Dean for Graduate Medical Education at the University of Texas Southwestern Medical Center in Dallas, told the subcommittee.

ACP is the largest specialty society in the U. S., representing 120,000 internal medicine physicians and medical students. More Medicare patients count on internists for their care than any other type of physician.

"Medicare will pay for an office visit or procedure," Dr Kirk pointed out. "But it will not reimburse for the time I spend following up with my patients on recommended self-management plans or for coordinating care among a team of health professionals. It will not reimburse for use of health information technologies that will enable me to track and improve the care I provide."

Using graphics, Dr. Kirk illustrated that health care managed by a patient's personal physician can achieve better outcomes at lower costs. She also noted 10 clinical conditions where "effective diagnosis, treatment, and patient education can help control the exacerbation of an illness and prevent or delay complications of chronic illness, thus reducing hospitalizations."

The American Academy of Family Physicians recently joined ACP in describing the key elements of a patient-centered medical home (PC-MH). The four-part PC-MH will create incentives for each patient to have a relationship with a personal physician trained to provide first contact, continuous and comprehensive care, working with a team that collectively take responsibility for the ongoing care of patients.

Other elements call for:

  • care coordinated using registries and information technology
  • patient participation with enhanced access through systems such as open scheduling and email consultations
  • accountability with regular reporting on the quality of care provided

"The patient-centered medical home requires a completely different way of reimbursing physicians," Dr. Kirk emphasized. "Payments should reflect the value of services involved in coordinating care. This should include payment for care coordination that falls outside of an office visit. Payments should be sufficient to support practices in acquiring the needed information technologies. Physicians in a patient-centered medical home should be able to earn higher performance-based payments and share in savings from reductions in avoidable hospitalizations attributable to them."

"As a pilot test of the patient-centered medical home is being implemented, Medicare should also begin a broader effort to link payments to reporting on quality measures," Dr. Kirk continued. "This program should be based on the work being done by the AMA's Consortium for Performance Improvement, the National Quality Forum and the AQA. ACP was one of the four original founding members of the AQA. Today, the AQA includes over 100 stakeholders working collaboratively to select uniform, transparent and evidence-based physician performance measures."

Dr. Kirk told the sub-committee that ACP believes that a Medicare pay-for reporting program should:

  • Be voluntary, thereby making certain participants receive positive performance based payments, and are not penalized
  • Be funded by dedicating Part B dollars toward creating a physicians quality pool
  • Include development of a methodology to redirect a portion of savings in other parts of Medicare
  • Begin with high impact prioritized clinical measures for procedures selected for implementation by the AQA
  • Allocate payments to physicians on a weighted basis
  • Include safeguards to take into account differences in patients' severity of illness and compliance with recommended treatments

"Congress can maintain a flawed system that rewards fragmented, high volume, over-specialized and inefficient care," Dr. Kirk said in concluding her testimony. "Or, it can put Medicare on a pathway to a payment system that facilitates high quality and efficient care centered on patients' relationships with their primary and principal care physicians."

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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 120,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.


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