Blog: In Ore., training medical residents for a new practice environment

If the patient-centered medical home supported by per-member, per-month care-management fees becomes the standard primary-care practice model, then Oregon Health & Sciences University in Portland can claim to be its first training ground.

When the CMS announced the names of the 500 participants in its four-year Comprehensive Primary Care Initiative, the list included three OHSU primary-care clinics where residents are trained.

The CPCI begins with Medicare providing a $20 per-member, per-month care-management fee, with that sliding back to about $15 after the second year, when practices will be eligible to collect money from shared savings. Some private payers and state Medicaid programs are also participating in the CPCI, and—with Medicare, Medicaid and private payers combined—the program's goal is to have at least 60% of the participating practices' patient base covered by per-member, per-month fees. The intent is to have the practices use that money to invest in the staff and information technology necessary for care-coordination services that should help lower hospitalizations, eliminate duplicate testing and avoid other inefficiencies that drive up healthcare costs.

Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans of Grand Junction, Colo., says the program has the potential to "fundamentally change the economics of primary care."

According to Dr. John Saultz, OHSU professor and chairman of its family medicine department, the three Portland clinics could become the prototype for training residents in this new practice environment.

"We're excited about this," Saultz says.

"We've been trying to change the way we train new (primary-care) physicians, nurses and social workers to practice in this model," Saultz added, explaining that the care-management fee can help support mental health services, outreach programs and home healthcare delivery.

Though it doesn't sound like much individually, he says the numbers add up, and said that—if a practice collects fees from 2,000 patients—it could equal "twice the salary of the average family doctor."

Dr. Glen Stream, president of the American Academy of Family Physicians, also endorsed the program.

"It aligns so much with our vision of the patient-centered medical home payment model," Stream said, though he added—in the AAFP's vision for payment reform—a pay-for-performance bonus would take the place of shared savings.

The 500 practices are in seven areas: New York's Capital District-Hudson Valley region; the Ohio-Kentucky Cincinnati-Dayton region; Tulsa, Okla.; and statewide in Arkansas, Colorado, New Jersey and Oregon. According to the CMS, most efforts will launch around Nov. 1, with Tulsa practices aiming for Oct. 1.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.



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