Implement PCMH Nationwide, Says FP Who Has Made Journey

Congress should mandate adoption of the patient-centered medical home (PCMH) on a nationwide basis to improve the overall quality of care and to help reverse escalating costs that are burdening the American taxpayer. That was the gist of testimony given by family physician John Bender, M.D., during a Feb. 7 hearing of the House Ways and Means Committee's Subcommittee on Health.

The PCMH "is now being proven and adopted in the private sector," said Bender, CEO and medical director of Miramont Family Medicine in Fort Collins, Colo., and a past president of the Colorado AFP. During the hearing, which focused on possible private-sector solutions to the Medicare payment formula dilemma, Bender called on the subcommittee to "compel HHS to immediately deploy the PCMH payment standard nationally." Adoption of the PCMH model on a nationwide basis also would help preserve the primary care workforce, Bender told the subcommittee.

Bender testified as part of a five-member panel that included representatives from UnitedHealth Group of Minnetonka, Minn.; Blue Cross, Blue Shield of Michigan; the American College of Cardiology; and the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Va.

During his testimony, Bender described the transformation of his own practice into a nationally recognized PCMH with four locations in Colorado. When Bender and his wife bought Miramont in 2002, it was one of the oldest practices in Fort Collins and had changed little since the 1970s. "They left us one computer and one employee," said Bender about the previous owners. "That was 10 years ago. Today, we have over 50 employees and 14 providers, including eight physicians. We have over 80 computers in a centralized data center, serving four different parts of our state and we have over 27,000 patients."

According to Bender, during that same 10-year period, 34 primary care practices in the county closed their doors or stopped providing primary care services. Eight of the 34 practices declared bankruptcy, he said.

"Yet at the same time, we saw a doubling in the number of emergency room beds and an increase in the number of emergency room physicians by 50 percent, suggesting that if patients did not have a patient-centered medical home like myself, they were going to the emergency room at a later stage of their illness at a higher cost," Bender said. This increases health care premiums for everyone across the state, he added.

Bender noted that he and his colleagues made a conscious decision to no longer focus on patient volume. "We were going to make sure we had a high-quality product that was safe and efficient," Bender said. "We believed that if we built the best product in the marketplace, consumers would vote with their feet, and we would be able to maintain solvency."

Miramont started the process by working to achieve recognition as a PCMH.

"That basically meant that after six months, we were able to show improvements in our workflow and the way we retooled things so we could deliver team(-based) care," said Bender.

Miramont also provided patients with a patient portal, allowing them to go online and look at their lab results and clinic records and to schedule appointments. In 2008, Miramont started participating in a multipayer PCMH pilot project in Colorado that includes the nation's five largest payers, as well as employers and physicians, who all agreed to adhere to the same quality metrics and a three-tiered payment system.

The payment system is based on fee-for-service; per-member, per-month fees; and pay-for-performance, said Bender, noting that according to payer UnitedHealth Group, Miramont reduced hospital readmission rates by 83 percent compared with other practices in the pilot.

During the question-and-answer period, Wally Herger, R-Calif., chair of the health subcommittee, asked Bender what advice he had for other physicians struggling to make practice changes in spite of a dysfunctional Medicare payment system.

"They need two things -- leadership and courage," Bender answered. "Leadership means getting involved in the patient-centered medical home. They have to tell their staff, 'We are going to do this.'"

For their part, employees of a practice have to believe in the PCMH model to implement it, said Bender. "The group has to eat, sleep and drink the model." And although it's a difficult change to go through, he added, it pays off in the end.

"People hate change, but they love progress."