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CMS Supports AMA/RUC Payment Scale for Medical Home Demo
Final Figures Require CMS Vetting to Ensure Budget Neutrality
CMS has modified the three-tiered medical home recognition program developed by the National Committee for Quality Assurance, or NCQA, to determine payment recommendations for the demonstration project. The three-tiered payment system would provide
- an estimated $30 per-member, per-month for a tier one medical home;
- an estimated $40 per-member, per-month for a tier two medical home; and
- an estimated $50 per-member, per-month for a tier three medical home.
"We have a reflection of what the (RUC) committee believes would be a fair compensation for medical home services," said Coan. "But no one has done calculations about how much this would actually cost using these rates and, therefore, how much would have to be saved in order to cover these costs and make it budget-neutral."
Although CMS will start recruiting practices for the demonstration project in early 2009, it will not start paying practices in the project until 2010, said Coan. CMS will choose practices based on whether they have met the qualification criteria laid out in a special CMS demonstration version of the NCQA's medical home recognition program.
"Practices are going to have to comply with qualification criteria to participate in the demonstration," said Coan. "That process could take months; therefore, we want to give practices as much time as we can so they can comply."
Congress, meanwhile, appropriated an additional $100 million for the demonstration project as part of the recently enacted Medicare Improvements for Patients and Providers Act of 2008. The law gives the HHS secretary the authority to expand the duration and scope of the demonstration project if certain quality and saving targets are achieved.
CMS officials are not clear on how the $100 million should be spent, Coan said.
"The legislative language is less than descriptive," he explained. "It just says there is an additional $100 million but not exactly what it is for."
National Demonstration Project Concludes
TransforMED Practices Reflect on Success, Challenges
(4/18/2008)
Patient-Centered Medical Home
NCQA Fires Up National Recognition Program
(2/7/2008)
More from AAFP
Family Practice Management: "What Every Physician Should Know About the RUC"
(Members Only)
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