News From the 2008 AMA Annual Meeting

Delegates Seek Closer Ties Between Medical Education and PC-MH

By Barbara Bein • Chicago
6/25/2008

The patient-centered medical home, or PC-MH, got a boost during the 2008 annual meeting of the AMA House of Delegates here, when delegates adopted a set of recommendations aimed at ensuring physicians-in-training are primed for practice in the PC-MH setting.

The recommendations, only slightly amended from those originally included in a report by the AMA Council on Medical Education, encourage "the integration of medical education into PC-MH demonstration projects" and direct the AMA to advocate funding of medical schools and residency programs that can educate students and physicians-in-training within a PC-MH context.

The delegates also called for the AMA to

ask the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education to review their respective accreditation standards to ensure that their processes don't impede education in and about the PC-MH model, and
monitor the evolution of the medical home concept and track whether teaching programs are implementing it.

The delegates further requested a report back on the teaching programs' progress by the 2010 annual meeting.

Most participants who testified before the medical education reference committee spoke strongly in favor of adopting the report's recommendations. Many pointed out that the number of Americans with chronic medical conditions is increasing, a fact that they said boosts the need for coordinated care, such as that provided within the PC-MH, to manage those conditions effectively.

"This does, in fact, work," said James Dearing, D.O., referring to the PC-MH model of care. Dearing spoke on behalf of the American Osteopathic Association at the June 15 reference committee hearing, but also is a member of the AAFP Board of Directors.

The AAFP; the American Academy of Pediatrics, or AAP; the American College of Physicians, or ACP; and the American Osteopathic Association, or AOA; all have endorsed the PC-MH model of care, (3-page PDF; About PDFs)
which calls for patients to have an ongoing relationship with a personal physician who provides "first contact, continuous and comprehensive care" for patients in all stages of life, as well as across the entire health care system.

The medical home model, increasingly embraced by CMS, private payers and large, self-insured employers, recently has sparked a number of demonstration projects, such as Community Care of North Carolina, or CCNC. The CCNC network, which cares for almost three-quarters of North Carolina's eligible Medicaid beneficiaries, has been credited with saving as much as $260 million in 2004 when compared with traditional fee-for-service programs.

The medical education council's report cites a number of implementation issues that need to be addressed to facilitate the medical home concept's incorporation as a teaching venue.

Teaching sites require restructuring so students and residents can work in teaching practices with medical home features. For family medicine alone, the report states, practices associated with more than 100 medical school programs and more than 450 residency programs would need to be remodeled.
Financial barriers must be surmounted, including problematic reimbursement issues, uncertainties about billing and coding, and, often, a lack of resources for proper staffing and for electronic health records and registries.
The payment systems used by Medicare, Medicaid and most private payers must be redesigned to provide incentives for physician practices that organize themselves according to the PC-MH model.
Major stakeholders in the PC-MH concept have had to develop uniform standards of measurement. The AAFP, the AAP, the ACP and the AOA worked with the National Committee for Quality Assurance, deciding on measures that will allow uniform implementation of the medical home concept. The promotion of those measures continues.

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