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Reform Update: Specialty physicians make inroads into medical homes

The proposals to scrap Medicare's sustainable growth-rate formula for updating physician pay include less-noticed provisions rewarding practices that operate as a patient-centered medical home. There is a twist, however.

The medical home practice model was developed by primary-care medical societies, and the concept's principles include a “whole person orientation.” So, even though a patient may receive the bulk of their care from a cardiologist or oncologist, that practice—by the primary-care societies' definition—can't be a medical home because of the focus on one organ system or one disease condition.

But it appears that Congress and organizations such as the National Committee for Quality Assurance disagree with the primary-care docs on this one.

“Congress is rapidly advancing Medicare physician payment reform legislation that rewards value over volume for patient-centered medical homes and patient-centered specialty practices,” said Margaret O'Kane, NCQA president.

O'Kane noted that the legislation—as well as the 2014 Medicare physician fee schedule—include measures that would reward practices for services typically associated with medical homes such as non-face-to-face care-management services for patients with two or more chronic conditions.

The NCQA has recognized 6,550 practices as medical homes, and O'Kane said medical homes and patient-centered specialty practices could serve as platforms for “alternative payment models” that move healthcare away from fee for service.

The private sector is moving faster than the government—particularly in the area of financially rewarding oncology practices that operate as medical homes.

Last year, Grand Rapids, Mich.-based health plan Priority Health teamed up with oncology health information technology provider ION Solutions and others to form a three-practice oncology medical home demonstration project. More recently, Hartford, Conn.-based Aetna launched similar programs in Pennsylvania and Texas.

“We are exploring a number of different reimbursement models,” said Dr. Michael Kolodziej, Aetna's national medical director for oncology strategy. He added that these new models, such as primary-care and specialty-practice medical homes, move healthcare payment away from its “traditional transactional model” and toward a system with more built-in quality measures and accountability.

Aetna is building a network of community oncologists “who have the same skill set” as those involved in the Pennsylvania and Texas programs, Kolodziej said. The oncology medical homes, he said, could better manage the treatment of side effects and reduce unnecessary readmissions to the hospital. “It's going to improve quality and the extra special bonus is that I think it will control costs.”

Primary-care docs in Calif. receive parity provision money

The 7,000 California doctors who attested before November as primary-care providers received $65 million last month under the Patient Protection and Affordable Care Act's Medicaid parity provision.

The provision calls for primary-care providers to be paid at Medicare rates for two years. The payment parity was effective Jan. 1, but implementation was slow and California's parity plan was not approved by the CMS until this past October, the California Medical Association reported. The state began making retroactive payments last month, and another round of payments is expected this week.

Since last month, the number of attested primary-care providers has more than doubled and is now up to 14,654. The California Department of Health Care Services reported that it will be releasing $22 million to the newly attested providers this week.

The CMA had more good news to report. California was set to implement a 10% paycut to its physicians who treat patients under Medi-Cal, the state's Medicaid program. But now, according to the CMA, California is projected to have a budget surplus, and some lawmakers are looking to use that money to restore funds that had been cut from state programs—including Medi-Cal.

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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