Congressional panel questions outcomes of patient-centered medical homes

In the wake of a recent study that found patient-centered medical homes don't significantly improve quality or save money, a congressional agency questioned the model and its payment mechanisms.

The Medicare Payment Advisory Commission (MedPAC) expressed concern last week during a public hearing with the PCMH recognition standards and bonuses that practices receive for treating patients in a medical home.

MedPAC Chair Glenn Hackbarth said that the National Committee for Quality Assurance requirements for medical homes add a lot of "bells and whistles" that don't appear to add value, only cost. "I'm worried that maybe the medical home model has a real cost disadvantage," he said in a transcript of the meeting. 

MedPAC members discussed the need to align physician bonuses with specific outcomes and eliminate the standard per-beneficiary-per-month payment. However, they said they need to make sure payment changes don't result in limited practitioner participation. 

The comments add to the criticism about the medical home model following the publication of a study in the Journal of the American Medical Association. The study assessed one of the country's earliest and largest medical home pilots. Researchers said the Southeastern Pennsylvania Chronic Care Initiative showed limited quality improvement and failed to save money over a three-year period.

However, the findings run counter to the success of many PCMH models, including the Montefiore Medical Group in the Bronx, N.Y. and Atrius Health in eastern Massacusetts.

Last year an analysis of Blue Cross Blue Shield of Michigan's PCMH program found that practices that fully implemented the model achieved a 3.5 percent higher quality measure, a 5.1 percent higher preventive care measure and a $26.37 lower per member per month medical cost for adults, FiercePracticeManagement previously reported.

To learn more:
- read the transcript from the MedPAC public hearing (.pdf)
- here's the NCQA PCMH recognition requirements