The Patient-Centered Medical Home

In a 2014 article published in Health Services Research, researchers compared health care utilization and payments between the National Committee for Quality Assurance (NCQA) recognized patient-centered medical home (PCMH) practices and practices without such recognition. The study conducted three annual observations between 2008 and 2010, in which the authors compared selected outcomes between practices.

Source: Nate Smith (Flickr / CC)

Source: Nate Smith (Flickr / CC)

Variation in difference estimates indicated that relative to the comparison group, emergency room visits among those using NCQA-recognized PCMHs declined significantly for all ambulatory care sensitive conditions (p<.001). Other utilization measures, such as hospitalizations, 30-day readmission rates, annual visits, were not affected by the NCQA PCMH designation. However, total Medicare payments for practices that received the designation declined by $265 (p<.05) relative to comparison practices. Sixty-two percent ($164, p<.05) of this decline was attributed to a relative decline in payments to acute care hospitals.

The authors also performed regression estimates for selected outcomes by three levels of average Hierarchical Condition Category (HCC) risk score, practice type, and practice size. NCQA-recognized PCMHs demonstrated a significant decline in emergency room visits for all three levels of average HCC risk score, with the largest decline noted among those PCMHs with the sickest patients (p<.001). PCMHs with a primary care model demonstrated significant decline in total Medicare payments (p<.01), emergency room visits (p<.001), and ACSC emergency room visits (p<.001).

What does this all mean? This study contributes to the growing evidence base that upholds PCMHs as the new standard for providing cheaper, more efficient care. One remaining question posited by the authors, and certainly of interest to the nurse practitioner audience, is whether or not the PCMH model is associated with net cost savings. Nurse practitioners are often touted as a partial solution to rising health care costs as they have demonstrated competency in providing both preventative care and routine management of chronic disease, while demanding a lower salary than their physician counterparts. Further research on the net-savings of PCMHs, which examines the blend of doctors and nurse practitioners in PCMHs as opposed to physician-only primary care practices, would be of value.

commentary by Megan, Doede, RN, BSN, CEN

Abstract

Objectives: To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Data Sources: Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare’s Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. Study Design: This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Methods: Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Findings: Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. PMID: 25077375 Van Hasselt, M et al. Health Serv Res. 2015 Feb; 50 (1): 253-72.

2 Replies to “The Patient-Centered Medical Home”

Comments are closed.