Experts Dive Into Realities of Patient-Centered Medical Homes

FP Shares Pros, Cons of His PCMH Journey

June 04, 2014 04:06 pm Michael Laff Washington, D.C. –

In a climate of high expectations for the patient-centered medical home (PCMH) model, a panel of experts recently cautioned that results such as improved patient health outcomes and reduced care costs won’t happen overnight. For the new care delivery model to work, physician practices should be prepared to devote the necessary time and resources to ensure it succeeds.

Mark Frazer, M.D., discusses how he made the transition to a patient-centered medical home during a recent panel discussion in Washington.

On May 30, the Alliance for Health Reform hosted an event( titled “Patient-Centered Medical Homes: The Promise and the Reality” here. The event attracted a large crowd of legislative staff members and others with ties to the medical profession.

Among proponents, there is a general anticipation that PCMHs have the potential to boost care quality and reduce both hospital costs and overall health costs. But because understanding about their impact is still limited, a single article reporting less-than-stellar research findings can sidetrack the discussion. It’s essential to realize, however, that just as the transformation process itself can’t reasonably be accomplished in a matter of weeks – and possibly even longer – the results of that transformation won’t become evident right away.

“It will take five years after the trial period when information about medical homes will demonstrate health outcomes,” said Amy Gibson, chief operating officer of the Patient-Centered Primary Care Collaborative (PCPCC). “You can’t just order it on next week and put it into a primary care practice overnight and say, ‘Now, we’re a patient-centered medical home.’”

Story highlights
  • Expectations about the potential for improved outcomes and cost savings associated with the patient-centered medical home (PCMH) need to be tempered by reality, a panel of experts said recently.
  • Physician practices should be prepared to devote adequate time and resources to shift to a PCMH model.
  • One family physician said that despite some growing pains, the new model has proved especially rewarding in his practice.

Gibson noted that comparisons between different medical homes likely won’t provide insight because the patient populations will vary greatly, as will the skills of the medical professionals who work in a given care team.

Still, Gibson added, the PCPCC plans to soon publish a map of 500 medical homes online that will include payment information.

There are several major benefits to implementing the PCMH model, the panelists noted. Access to care is increased -- with extended hours and weekend hours being added in many practices -- ER visits are reduced, the rehospitalization rate is lowered and patients are taught the skills they need to manage their condition.

However, physicians considering the change must be prepared to make a major transition for the first couple of years.

“Patient-centered medical homes are not a tweak to the fee-for-service model,” said Amy Cheslock, vice president for WellPoint Inc. “It is a fundamental shift.”

Cheslock noted that primary care is the foundation of the health care delivery system that can help achieve cost savings, yet it has been “underresourced” in terms of payments to physicians.

Results regarding the effectiveness of new payment models may be years away, but the participation rate in such models is growing rapidly. In January 2013, WellPoint had 2,000 primary care physicians working in a value-based contract. Now, the insurer has 32,000 primary care physicians participating in a shared-savings payment model.

Cheslock said WellPoint is working with several small, independent practices as they shift to a coordinated care approach. It is not necessary for a physician practice to be affiliated with a large institution or a consolidated network to make this shift, she pointed out.

AAFP member Mark Frazer, M.D., who founded Ohio-based Summit Family Physicians in 1985, shared his experiences in making the transition to a PCMH. The practice, which gained PCMH Level 3 recognition from the National Committee for Quality Assurance in 2012, includes three physicians, a nurse practitioner and 18 other staff members.

Frazer said his practice received funding through the Comprehensive Primary Care Initiative (CPCI) to help make the transformation. Primary care practices that participate in the CPCI receive support from private and public health insurers. The program blends fee-for-service payments with a per-patient, per-month care coordination fee and also offers practices the opportunity to earn a portion of shared savings.

Frazer didn’t hold back in describing both the ups and downs his practice has gone through in its PCMH implementation course. For example, with the additional responsibilities for each patient that are part of the PCMH model, Frazer said the physicians in his practice now visit with 15 percent to 20 percent fewer patients each day. He also admitted that revenue was flat during the first two years of his practice’s transformation, when an electronic health records system was being implemented.

Yet, despite the need to overcome some major hurdles, Frazer dismissed the notion that the model is especially difficult for small practices to adopt.

“I don’t think size is the determining factor,” he said. “It’s your willingness to embrace the model.”

Frazer acknowledged that he and his staff have worked longer hours during the transition, particularly as the volume of information his staff needed to review grew much larger and they took on other responsibilities. Still, he noted, the level of satisfaction among staff has continued to improve throughout the transformation process because they see patients are receiving comprehensive care. Turnover has dropped, and for the few positions that have come open, it’s been easier to find and hire highly competent professionals.

Overall, said Frazer, “Our motivation for doing this was we truly believe that the medical system is broken,” he said. The primary care physician shortage continues, patient care is becoming increasingly fragmented, and the same ills that have plagued the system for years drag on. But those factors have just bolstered his determination to fully implement the PCMH model.

Why? “Because that’s what patients deserve,” Frazer said.