Principles for Physician Payment Reform to Support the Patient-Centered Medical Home (Position Paper)
A physician payment system should:
- Recognize the value of whole-person care delivered in a patient-centered medical home (PCMH) including physician and non-physician work for:
a. face-to-face services
b. patient care management that falls outside of face-to-face encounters, consistent with AAFP policy on Care Management Fees
- Reward PCMH activities that improve patient outcomes, enhance population health, improve the professional satisfaction of health care providers, and reduce total health care spending through incentives that:
a. allow physicians to share in savings from reduced total health care spending
b. reward measurable and continuous quality improvements
c. support physicians in engaging patients as partners through shared decision-making and the development of strong, enduring, healing relationships
d. support the efficiencies of team-based care
e. support the use of evidence to guide clinical decision making
f. prioritize the provision of comprehensive primary care services
- Compensate for the physician practice’s investment in technology, infrastructure, and services that enhance patient access and improve care coordination, including:
a. improved patient care communication (e.g. a secure, Web-based patient portal that supports synchronous or asynchronous e-mail and virtual visits and telephone consultation)
b. use of health information technologies (e.g. patient registry systems, evidence-based clinical decision support, electronic health records, etc)
c. practice transformation and innovation (e.g. staff training, work flow redesign and practice recognition requirements)
- Include a transparent process that ensures the payment model accurately accounts for the cost of operating an efficient practice, including but not limited to, inflation, patient demographics (e.g. socioeconomic status, age, and gender), practice setting (e.g. rural/urban), and disease severity/case mix.
- Promote accountability for achieving better results by linking a portion of payment to reporting on appropriate evidence-based measures of care, including structural, process, and outcomes measures. Performance measures included in payment and reporting systems must be valid, meaningful to all stakeholders, and harmonized across all payers. Payment must exceed the additional costs of reporting.
- Include standardized administrative and reporting requirements and business rules across all payers including, but not limited to, interfaces for eligibility, benefits, deductibles, and real time claim submission/payment.
- Allow for blended approaches to payment to counter-balance unintended consequences associated with using any single approach to payment.
- Achieve an appropriate balance in income between primary care and sub-specialty physicians as a means to help ensure that there are sufficient primary care physicians.
(2010 COD) (2016 COD)