Medical Home Demonstration an Attempt for Reform

In 2007, Medicare Part B covered almost 41 million people with benefit payments equaling $176.4 billion. National health care costs are projected to reach $4.3 trillion in 2017, up from $2.1 trillion in 2006 (Brief Summaries of Medicare & Medicaid, Nov. 1, 2008).

Although the consensus is out on how to decrease health care costs and increase coverage without sacrificing quality of care, everyone seems to agree that these things must be done.

“Health care is broken, with gaps in quality patient care, and the primary care field in crisis,” said Thomas Knabel, M.D., vice president, Ingenix Medical Informatics (Ingenix Innovations, Nov. 12). “Although the current reimbursement paradigm favors acute care over preventative care, some of the highest costs to the system come from poorly managed chronic conditions.”

The pursuit for health care reform has led some to consider a concept that’s been around since 1967, called the “medical home.”

Since its inception, the medical home concept has evolved. “The goal of the ‘medical home’ today is to change the reliance on patients to communicate every piece of relevant information to all of their caregivers,” said Knabel.

In essence, physicians who participate in the medical home do what primary care physicians were originally intended to do—direct their patients’ total care. The difference is, physicians are paid an additional fee for the service.

On the Horizon
The Centers for Medicare & Medicaid Services (CMS) is planning a demonstration to see if the concept of the medical home is feasible. Section 204 of the Tax Relief and Health Care Act of 2006 requires the Department of Health and Human Services (HHS) to establish a three-year medical home demonstration project by 2010. The program, still in the planning stages, would provide a care management fee to physician practices for the services of a “personal physician” providing “targeted, accessible, continuous and coordinated, family-centered care to high need populations.”

According to CMS, “high need patients include those with prolonged or chronic illnesses that require regular medical monitoring, advising, or treatment.”

The demonstration project’s design is slated for completion this fall, with provider recruitment beginning in the spring of 2009 and project startup in 2010.

For more information regarding physician and patient eligibility, CMS’s two-tier definition of medical home, and reimbursement rates, see CMS Fact Sheet “Medicare Medical Home Demonstration.”

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One Response to “Medical Home Demonstration an Attempt for Reform”

  1. Eileen says:

    As a patient with a chronic condition, I see the need for “coordination of care” with all of my caregivers. In essence, the Medical Home idea sounds feasible; I am afraid, however, if you put a pricetag on it by reimbursing physicians who agree to do what should be done anyway (that is communication with all care givers) you will have those that comply and those that say they will but don’t. Preventative medicine should be higher on the list of standard medical care, and payable. However, conditions like mine are not detectable through a routine physical either. It would be a miracle if all patients were treated the same.

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