3 considerations for becoming a patient-centered medical home

The benefits for patients of belonging to patient-centered medical homes (PCMH) have been well-documented, but the advantages to practices, at least in the short term, are tougher to discern.

Before beginning the arduous and costly process of becoming certified by the National Committee on Quality Assurance to become a PCMH, it makes sense to do a cost-benefit analysis. A recent article from Medscape Business of Medicine offers some important considerations:

  • You're likely already following PCMH-worthy best practices, just not documenting them. "I have not seen anyone object to what's required," Margalit Gur-Alie, a founder of the St. Louis-based BizMed that guides clinicians through the process, told Medscape. "It's not the substance that's the problem; it's the form." Changing processes to capture this work, the article added, can be less cumbersome for small practices than for larger organizations.
  • You have to spend money to make money. According to a recent study from the Medical Group Management Association, PCMHs report higher general operating costs than non-PCMH practices ($218,800 vs $187,345 per full-time-equivalent [FTE] physician) and higher total support staff cost ($232,346 vs $193,389). It's possible that some of the practices that seek the PCMH designation are higher performing and more fully staffed to begin with, experts noted, adding that PCMHs take in more revenue per FTE as well. Specifically, the MGMA report found that PCMHs made $754,667 per FTE, compared with $624,405 for non-PCMH practices.
  • Payers are noticing the benefits--gradually. Some health plans already work with practices to reward PCMH designation. For example, PCMH practices generally get an additional $2 to $3 per member per month allocation from Aetna, intended to help them have predictable payments, expand technology and add staffing, Elizabeth Curran, head of National Network Strategy and Program Development for Aetna, told Medscape. If your payers aren't offering compensation for becoming a PCMH, Susanne Madden, CEO of The Verden Group, a practice management consulting firm in Nyack, N.Y., told Medscape. "Often," she said, "that ends up with the practice getting enhanced rates or becoming part of a pilot; our clients become the driving force."

To learn more:
- read the article from Medscape

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