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I'm Not a Doctor

A second opinion on the challenges and opportunities facing today's physicians.
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By Andis Robeznieks

Blog: Will this (medical-home) pilot fly?

The 500 medical practices participating in the CMS Comprehensive Primary Care Initiative are going to be under a lot of pressure, as it is now up to them to prove that the patient-centered medical-home model works clinically and economically.

Let's face it: Government-sponsored pilot programs and demonstration projects come and go. Most produce some headlines at their launch, then they generate a few research papers a year or three after their completion, and then they're forgotten.

But hopes are higher for the CPCI, which was described as "very well-conceived, well-designed and, so far, a well-executed program" by Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans based in Grand Junction, Colo., an area contending for the country's coordinated-care crown.

The key to the four-year effort is that around 60% of the patient bases for participating practices will be covered by plans providing per member, per month management fees. In the case of Medicare, it will be $20, with the fees for Medicaid and other participating private payers yet to be determined.

According to Gordon, it could "fundamentally change the economics of primary care" if the care coordination results in fewer hospitalizations and lower global costs to the country's healthcare bill.

"I'm hoping this is at least the beginning of the recognition of primary care as a valuable resource," said Dr. John Reed, founder and owner of New Windsor Family Medicine, located in another medical-home hotbed, New York's Hudson Valley region. "I think this is an exciting initiative because, historically, primary care has been undervalued. What I'm hoping is that this initiative will go a little way toward evening the playing field."

One of the smaller practices in the demo, New Windsor Family Medicine has a staff of eight which includes two full-time doctors and one part-time physician assistant. Reed says he hasn't gone through the medical home recognition process because it's too "time-intensive" for his small-but-busy all-electronic practice.

"We don't have any paper charts in our office," Reed said, adding that—without a health IT infrastructure—it would take a tremendous amount of staff time to maintain patient registries and track the treatment of patients with chronic conditions. "Every aspect of our office relies on it."

Going into the initiative, Reed said he's concerned that their participation would "add another layer of administrative work" and that he would have to spend additional money before the care management fees start to roll in—but he won't back out.

"I think this is an exciting initiative," he said. "We're going to be put to the test to prove that we're delivering better quality of care."

Care to make a prediction? Drop me a line at arobeznieks@modernhealthcare.com or send me a message on Twitter at @MHARobeznieks.

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