Patient-Centered Medical Home Is Key to Health Care

Testifying before the House Ways and Means Committee's Subcommittee on Health here May 10, AAFP President Rick Kellerman, M.D., of Wichita, Kan., urged Congress to adopt a Medicare physician payment system that reimburses physician practices for providing a patient-centered medical home to manage and coordinate care.

Kellerman said such a medical home would improve health care quality and cost effectiveness while better integrating patient care into the overall health care system and increasing patient satisfaction.

"This well-known model is based on the fact that most health care for the chronically ill takes place in primary care settings, such as the offices of family physicians," said Kellerman, explaining that the medical home is founded on several components:

"This model, with its emphasis on care coordination, has been tested in dozens of studies and has repeatedly shown its value because of the prevalence of chronic disease among the elderly," said Kellerman. More than 80 percent of Medicare beneficiaries have at least one chronic condition, and two-thirds suffer from more than one chronic condition, Kellerman testified. Twenty percent of Medicare recipients have five or more chronic conditions, accounting for two-thirds of Medicare spending.

"More than 20 years of evidence shows that having a health care system based on primary care reduces costs and benefits the patient's health," said Kellerman. "By using a system of health care that is not predicated on primary care physicians coordinating patients' care, the U.S. health care system pays a steep economic price, and our Medicare beneficiaries pay a steeper price in terms of their quality of care."

The AAFP supports a system in which patients would chose a medical practice as their medical home. Under a revised payment structure, Medicare would compensate physicians for coordinating care, a concept endorsed by the Institute of Medicine and the Medicare Payment Advisory Commission, or MedPAC, among others, said Kellerman. Medicare also would pay these medical homes for designated activities that fall outside the realm of face-to-face visits, such as coordination among consultants, ancillary providers and community resources.

Kellerman told the subcommittee that the AAFP and three other medical societies -- the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association -- have agreed on the principles of a patient-centered medical home. Among them, the AAFP and these other organizations represent a combined 333,000 physicians.

The AAFP and these other primary care specialty groups also are meeting with the National Committee for Quality Assurance to develop a special recognition program for the certification of medical homes, Kellerman said.

"In order to be recognized as a medical home, the practice will need to submit to a voluntary recognition process by an appropriate nongovernmental entity to demonstrate that it has the capability to provide patient-centered services consistent with the model," said Kellerman.

Panelist Herb Kuhn, acting deputy administrator for CMS, said the "medical home would be one of the many things (CMS) would need to explore." He told the subcommittee, "I don't think there is a silver bullet here anywhere." However, he noted, the medical home is "one of many things that can be helpful."

Another panelist, Robert Berenson, M.D., a senior health policy fellow with the Urban Institute, said "the vast majority of care should be coordinated through a primary care physician," and he called for a "multi-pronged approach to finding medical homes for patients." During his testimony, Berenson advocated the bundling of physician payments under Medicare, saying that the "bundling of payments for episodes of care needs to be a primary objective of physician payment reform."

"I think it is time to recognize that a one-size-fits-all physician payment system may no longer work properly to support the increasing diversity of physician activity that has resulted from subspecialization," he said.

You can read the AAFP's full written testimony to the subcommittee online; it's posted on the House Ways and Means Committee Web site.