Navigation Links
The price tag on a patient-centered medical home
Date:6/24/2012

The patient-centered medical home (PCMH) is a concept at the heart of many health care reform models that aim to both improve the quality of care and reduce wasteful spending. But a new analysis of federally qualified health centers finds that clinics with higher scores as medical homes also had higher per-patient operating costs.

The research, published online in the Journal of the American Medical Association and presented today at the AcademyHealth conference in Orlando, Fla., is the first national study to put a price on these additional costs.

"We're not saying that the medical home costs too much and we can't do it," said first author Robert Nocon, MHS, Senior Health Services Researcher at the University of Chicago Medicine. "Primary care providers today are being asked to implement a model and improve care in a way that will hopefully benefit patients and hopefully have a lot of good downstream impacts, but in a way that doesn't have downstream financial benefits for them. Instead, we need to build a system that promotes the care that we want to happen."

Patient-centered medical homes are clinics that provide access to comprehensive, high-quality primary care and case management. Research has shown that shifting patient care to these clinics can decrease health care spending by reducing hospitalizations and inappropriate emergency department use.

However, in the current system, most physicians will not benefit from these savings. Indeed, the new analysis suggests that many practices will incur additional expenses for turning a clinic into a true PCMH through spending on additional personnel, technology such as electronic health records, and quality improvement measures. The authors conclude that financial incentives must be designed to ensure that the PCMH model can be sustained.

"If policymakers want to have medical homes, then the current system is not set up to lead to that result," said co-author Marshall Chin, MD, MPH, Professor of Medicine at the University of Chicago Medicine. "It's pie in the sky unless the funding changes occur that support the people who are doing the medical-home work."

The study rated 669 health centers on a 100-point "Safety Net Medical Home Scale" based on the results of a survey assessing PCMH features such as access/communication, patient tracking, and quality improvement. For example, the scale measures whether patients can contact their clinician on a timely basis or the providers' ability to secure outside referrals for their patients. Those ratings were then correlated with health center costs using a database maintained by the Health Resources and Services Administration's Bureau of Primary Health Care.

The analysis found that the mean operating cost per patient per month for the clinics was $51.23. The cost of improving 10 points on the PCMH scale an "operationally meaningful" difference, the authors write would be an additional $2.26 per patient per month for an average health center. For the average patient population per clinic of 18,753 patients, that translates to more than $500,000 in additional costs annually.

"We know that the margins are thin in primary care, and our analyses show that the cost impact of this model is enough to eat into that significantly," Nocon said. "The things that we're asking these clinics to do as part of this model have a cost impact, and if we don't find ways to ensure that they can share in the financial benefits, it really is a risk to the sustainability of the entire model."

While significant, the additional costs of transforming clinics into patient-centered medical homes are far outweighed by potential health care savings. A 2010 study of an integrated delivery system utilizing PCMHs found savings of $18 per patient per month from reduced hospitalization and emergency department use.

However, for the majority of the U.S. health care system, the financial beneficiaries of increased PCMH utilization are separate from the primary care providers who bear the burden of additional costs.

Some of the models being tested by the Center for Medicare and Medicaid Innovation may remedy this disconnect between the savings and costs of implementing PCMHs. Accountable care organizations, entities that provide both primary and specialty care for their patient population, can bring these costs and savings together under a single budget. Another example, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration, pays health centers $6 per Medicare beneficiary per month to implement the PCMH model. Policy changes, such as increasing reimbursement rates for primary care in a PCMH clinic, also would help relieve the financial burden for providers.

"In many ways, the patient-centered medical home is preventative care that keeps people from getting sick enough to go to the hospital in the first place," Chin said. "If we can shift the money we save from preventing that hospitalization or emergency department visit up front to preventive care, then that's one of the most promising solutions for how we can reduce the overall rate of rise of the U.S. health care budget and improve care at the same time."

Additional research is required to assess the value of a higher PCMH rating measuring whether the additional features and costs translate into better health outcomes for patients of these clinics. Other factors besides cost also may influence a clinic's ability to function as a PCMH, including size, geography and financial incentives for practice improvement.

"To improve coordination of care and effectively manage patients with complex conditions requires investment in staff and better information systems," said Melinda Abrams, vice president at The Commonwealth Fund, which co-funded the study. "That costs money upfront, but helps save money downstream due to reduced hospitalizations. This study points to the need to invest more in primary care to improve quality and assure value for patients."

Nocon will present the research at 4:30 p.m. Sunday at the AcademyHealth conference in Orlando. The study, "Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers," will be published online on the same day in JAMA. Additional authors include Sang Mee Lee of the University of Chicago; Ravi Sharma and Quyen Ngo-Metzger of the U.S. Department of Health and Human Services, Health Resources and Services Administration; and Jonathan Birnberg of Engaged Health Solutions.


'/>"/>

Contact: Rob Mitchum
robert.mitchum@uchospitals.edu
773-795-5227
University of Chicago Medical Center
Source:Eurekalert

Related medicine news :

1. Report using private health claims data shows prices are driving health spending growth
2. Study Casts Doubt on Value of Pricey Prostate Cancer Therapy
3. Higher medical home performance rating of community health centers linked with higher operating cost
4. Business Travel Harmful to Health: Medical & Personal Fitness Experts Announce "Exercise is Solution to Many Travel Ailments"
5. Oakworks Medical, a Division of Oakworks Inc., Oakworks.com, Manufacturer of Medical Tables and Positioning Devices Announces ISO 13485 Certification
6. UMMS researcher Victor Ambros, Ph.D., named co-recipient of 2012 Janssen Award for Biomedical Research
7. San Francisco’s Advanced Male Medical Center Announces Discount, Discusses Erectile Dysfunction
8. Alex Galindo, Attorney and Partner at Curd, Galindo & Smith, LLP, Court Wins Against the County of Riverside's Motion to Dismiss Medical Malpractice Case
9. Study shows no evidence medical marijuana increases teen drug use
10. Rejuv Medical In Sartell, MN Now Offering Stem Cell Treatments
11. Elderly prisoners need better medical care, according to report
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... ... 26, 2016 , ... PawPaws brand pet supplements owned by Whole ... enhance the health of felines. The formula is all-natural and is made from Chinese ... PawPaws Cat Kidney Support Supplement Soft Chews are Astragalus Root Extract and ...
(Date:6/26/2016)... Birmingham, Lake Orion, Clarkston, Michigan (PRWEB) , ... ... ... their direction with respect to fertility once they have been diagnosed with endometriosis. ... for tolerable intercourse but they also require a comprehensive approach that can help ...
(Date:6/25/2016)... ... 2016 , ... Austin residents seeking Mohs surgery services, can now turn to ... Dr. Russell Peckham for medical and surgical dermatology. , Dr. Dorsey brings specialization to ... fellowship in Mohs Micrographic Surgery completed by Dr. Dorsey was under the direction of ...
(Date:6/25/2016)... California (PRWEB) , ... June 25, 2016 , ... "With ... fit their specific project," said Christina Austin - CEO of Pixel Film Studios. ... customizable and all within Final Cut Pro X . Simply select a ProHand ...
(Date:6/25/2016)... CA (PRWEB) , ... June 25, 2016 , ... As ... with Magna Cum Laude and his M.D from the David Geffen School of Medicine ... and returned to Los Angeles to complete his fellowship in hematology/oncology at the UCLA-Olive ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 2016 Research and Markets has ... by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic Chemical), ... Parenteral) - Global Forecast to 2021" report to ... The global pharmaceutical excipients market is projected to reach ... 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... Capricor Therapeutics, Inc. ... company focused on the discovery, development and commercialization ... in its ongoing randomized HOPE-Duchenne clinical trial (Halt ... its 24-patient target. Capricor expects the trial to ... 2016, and to report top line data from ...
(Date:6/23/2016)... and INDIANAPOLIS , June 23, 2016 ... Lilly Diabetes Tomorrow,s Leaders Scholarship is any indication, the ... announced today online at www.diabetesscholars.org by the ... diabetes stand in the way of academic and community ... Foundation,s scholarship program since 2012, and continues to advocate ...
Breaking Medicine Technology: