PCMH Profile

Physician Benefits From State Program That Pays for Medical Home Status

February 17, 2009 04:30 pm Sheri Porter

Joseph Mambu, M.D., of Ambler, Pa., had the good fortune to be in the right place at the right time in the spring of 2008. Soon after Mambu's practice, Family Medicine, Geriatrics and Wellness, completed its participation in a two-year national demonstration project on the patient-centered medical home, or PCMH, run by AAFP's TransforMED LLC(www.transformed.com), it was accepted into a chronic care initiative with a payment incentive worth going after.

The Chronic Care Learning Collaborative of Southeast Pennsylvania, which is sponsored by the Pennsylvania Governor's Office of Health Care Reform, pays physicians a lump sum each year for three years. The amount of money available is tied to the recognition level a practice receives from the National Committee for Quality Assurance, or NCQA. The amount ranges from $28,000 to $95,000 per year depending on a practice's NCQA PCMH recognition level and the number of full-time and part-time physicians it employs.

The dollar amount is reduced by the percentage of a practice's revenue that is generated by nonparticipating insurance plans, such as Medicare, which, in Mambu's case, is 50 percent.

Mambu recently answered a few questions from AAFP News Now about what his participation in the Pennsylvania initiative means to his practice.

Q: How much money will your practice earn from this pilot program?

A: Our practice will see about a 12 percent increase in total revenue each year for three years, or nearly $39,000 per physician, per year, for each of our three primary care physicians. Our practice has attained a Level 3 NCQA PCMH recognition.

Q: Is money an important driver to increase physician participation in the medical home movement?

A: Yes, this has to translate into dollars for primary care because most family doctors are really small business owners, and they can't put this kind of money into the practice with no real promise of increased reimbursement. Without any kind of real substantive, significant financial benefit, the PCMH is just an academic exercise.

Q: How did TransforMED help you get where you are today?

A: TransforMED helped us develop the PCMH concept and then implement the components of the medical home. The Pennsylvania pilot program, known as SEPA, has been the icing on the cake because we went right from the TransforMED program to the SEPA pilot program. SEPA helped us deliver the chronic disease model to our patients and then agreed to pay us.

Q: Would you have applied for the NCQA's PCMH recognition program even if you hadn't been in a market that put money on the table?

A: We were going to get our NCQA recognition anyway, but we probably wouldn't have done it as quickly without a financial incentive. I give extra kudos to those practices that went ahead and got certified knowing there was no real remuneration.