Principles for Physician Payment Reform to Support the Patient-Centered Medical Home (Position Paper)

A physician payment system should:

  1. Recognize the value of whole-person care delivered in a PCMH including physician and non-physician work such as:
    1. face-to-face evaluation and management services
    2. patient care management that falls outside of payment for face-to-face visits, e.g. proactive preventive and chronic care management
    3. “medical neighborhood” care coordination (e.g. among hospitals, consultants, ancillary providers, and community resources)
    4. remote monitoring of biometric clinical data and patient support
  2. Reward PCMH activities which improve patient outcomes and reduce total health care spending through incentives that:
    1. allow physicians to share in savings from reduced hospitalizations, emergency room overuse, and high cost procedures
    2. reward measurable and continuous quality improvements
    3. support physicians in engaging patients as partners through shared decision-making and the development of strong, enduring, healing relationships
    4. support the efficiencies of team-based care
    5. support the use of evidence to guide clinical decision making
    6. prioritize the provision of comprehensive primary care services
  3. Compensate for the physician practice’s investment in technology and services which enhance patient access and improve care coordination such as:
    1. improved patient care communication, for example through a secure, Web-based patient portal that supports synchronous or asynchronous e-mail and virtual visits and telephone consultation
    2. acquisition and use of health information technologies (e.g. patient registry systems, evidence-based clinical decision support, electronic health records, etc)
    3. investment in infrastructure for practice transformation and innovation, e.g. staff training, work flow redesign and practice recognition requirements
  4. Include a transparent process that ensures the payment model accurately accounts for the cost of operating an efficient practice including but not limited to: inflation expense, patient demographics (socioeconomic status, age, and gender), practice setting (rural/urban) and disease severity/case mix.
  5. Promote accountability for achieving better results by linking a portion of payment to reporting on appropriate evidence-based measures of care, including structural, process and outcomes measures. Ensure that performance measures included in payment and reporting systems are valid and meaningful to all stakeholders and payment is more than the additional costs of reporting.
  6. Include standardized administrative requirements and business rules across all payers including, but not limited to:
    1. Standardized interfaces for eligibility, benefits, deductibles, and real time claim submission/payment
    2. Standardized reporting requirements
    3. Regional harmonization of measures
  7. Allow for hybrid approaches to payment to counter-balance unintended consequences associated with using any single approach to payment.
  8. Achieve an appropriate balance in income between primary care and sub-specialty physicians as a means to help ensure that there are sufficient primary care physicians.

(2010 COD) (2011 COD)