Patient-Centered Medical Home Gains Support in Congress

The patient-centered medical home has picked up key support on Capitol Hill during the past several months, increasing the chances that Congress will approve a nationwide patient-centered medical home demonstration project this year.

"The medical home model offers Congress a way to promote better health care quality while still controlling costs," said Kevin Burke, director of government relations for the AAFP. "This is a very attractive combination for Congress."

A House bill to reauthorize the State Children's Health Insurance Program, or SCHIP, which passed in early August, includes a provision to fund a nationwide medical home demonstration project that would allow as many as 500 medical practices to participate. It still is not clear whether Congress will approve the medical home provision as part of a final SCHIP bill worked out between House and Senate conferees.

According to Burke, Congress will approve the SCHIP demonstration project if there is money in the SCHIP bill to pay for it. "If the funding is there, it will survive because it is very popular," he said.

Under the House bill, the medical home project would operate for a three-year period, beginning on Oct. 1, 2009. It would include a nationally representative sample of physicians serving urban, rural and underserved areas of the country, encompassing practices with fewer than four physicians as well as larger practices, particularly in rural and under-served areas.

If enacted, the demonstration project has enormous implications for primary care in general and the patient-centered medical home in particular. "The value is that the model can be tested in different practice settings in different regions of the country," said Burke. "We'll have a much better knowledge of how it will work."

But even if the medical home demonstration project does not become law, it still serves as a prime example of the medical home concept's popularity on Capitol Hill. Medical home provisions are part of at least four bills now pending in Congress. In addition, the AAFP and other members of the Patient-Centered Primary Care Collaborative are meeting with Senate Minority Whip Richard Durbin, D-Ill., about introducing a stand-alone patient-centered medical home bill.

In the meantime, states, such as Colorado, Washington, Missouri and Louisiana, are moving ahead with the patient-centered medical home and passing legislation to organize Medicaid programs around the medical home concept. North Carolina has used existing legislative authority to extend the medical home concept to its Medicaid and SCHIP populations.