Reform Update: Proposals promote medical homes

Some day, primary-care physician organizations may hold celebrations marking July 2013 as a tipping point for them.

First, the CMS proposed creating new evaluation-and-management codes for non face-to-face activities relating to the coordination of care for patients with two or more chronic conditions. And, last week, a bipartisan draft bill from the House Energy and Commerce Committee's health subcommittee called for the creation of similar codes to promote coordination of care for individuals with complex chronic-care needs who are furnished items and services by multiple physicians and other suppliers and providers of services.

The CMS proposal solicited public comment on whether general third-party designation of a practice as a medical home could be considered evidence that the practice was up to the task of providing care-coordination services. But the draft of the House bill specifically mentions the National Committee for Quality Assurance's medical home and patient-centered specialty practice recognition programs.

Having recognized 5,770 practices as medical homes, the NCQA program is the largest program of its kind.

“NCQA is pleased that Congressional leaders on both sides of the aisle have included our programs in their framework,” Margaret O'Kane, NCQA president, said in a news release. “These programs are great for the patient, and it is gratifying to see them incorporated into Medicare as part of an initiative to help the healthcare system deliver better value.”

The American Academy of Family Physicians also applauded including medical-home payment reforms in the draft bill.

“We are particularly pleased the draft includes expedited recognition of patient-centered medical homes as an approved alternative payment model for medical practices,” Dr. Jeffrey Cain, AAFP president, said in a statement to the press. “The subcommittee's draft has taken an important step toward recognizing the value of continuous and comprehensive primary care, provided through a medical home, to patients with complex chronic disease, and we urge Congress to acknowledge the value of the medical home for all patients.”

Cain added, however, that family doctors are not pleased with all aspects of the bill. “We are disappointed that the subcommittee's draft does not include a provision to specify a higher base-payment rate for those services provided by primary-care physicians,” Cain said.

In the 20th annual Modern Healthcare Physician Compensation Survey, family physicians finished last among the 23 specialties tracked, with average compensation of $209,050. They finished just behind pediatricians, who had an average compensation of $209,986.

One of the foundations of healthcare reform involves boosting primary care. To this end, HHS recently awarded more than $12.4 million to support 300 primary-care residency positions at 32 Teaching Health Centers for the 2013-2014 academic year.

Administered by the Health Resources and Services Administration, the Teaching Health Center Graduate Medical Education program is a five-year, $230 million initiative created by section 5508 of the Patient Protection and Affordable Care Act.

In addition to pediatrics, and family and internal medicine, the awards will also help train residents in obstetrics and gynecology, psychiatry, and general and pediatric dentistry.

“This program not only provides training to primary-care medical and dental residents, but also galvanizes communities,” HRSA Administrator Mary Wakefield said in a news release. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”

The largest awards were given to the Wright Center for Graduate Medical Education, Scranton, Pa., $2.18 million; the Institute for Family Health, New York, $1.4 million; and Detroit Wayne County Health Authority, $1 million.

At its annual meeting in Chicago, the American Osteopathic Association House of Delegates voted to support the creation of state-level alternatives to Medicare funding of graduate medical education.

“With federal and state budgets looking to cut spending, GME programs are particularly vulnerable,” Dr. Joseph Giaimo, an AOA Board of Trustees member, said in a news release. “To address GME funding shortfalls, there is a critical need to examine all viable GME funding models.”

A similar resolution was adopted by the American Medical Association House of Delegates last month. That resolution called for the AMA to “collaborate with other organizations to explore evidence-based approaches to quality and accountability in residency education to support enhanced funding of GME.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks