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What is a Patient-Centered Medical Home?
The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for people of all ages and with all medical conditions. The PCMH facilitates partnerships between an individual patient, and his or her personal physicians, and when appropriate, the patient's family. Under the PCMH model, a physician-led medical practice, chosen by the patient, integrates health care services for patients who confront a complex and confusing health care system.
The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, initially referring to a central location for archiving the medical records of a child. In its 2002 policy statement, the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally sensitive.
In February 2007, the AAP, the American Academy of Family Physicians (AAFP), the American Osteopathic Association (AOA) and the American College of Physicians (ACP) used this 40-year old concept to develop a set of joint principles that describe a new level of primary care which they call the Patient-Centered Medical Home. These principles address the medical home partnership through which access --to specialty care, educational services, out-of-home care, family support, and other public and private community services important to the overall health of the patient - is facilitated. AGS officially signed on to these principles in October 2007.
The PCMH offers the benefits of a personal physician, with a whole-person orientation, who accepts overall responsibility for the care of the patient and leads a team that provides enhanced access to care, improved coordinated and integrated care, and greater emphasis on safety and quality.
The incentives of the PCMH model are aligned to facilitate improved communication and coordination of care between the personal physician and other treating physicians. The PCMH practitioner is not a "gatekeeper" who is rewarded for limiting access to specialists. Instead, patients have discretion in selecting specialists and subspecialists.
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Why is PCMH important for Geriatrics Care Providers?
The proposed PCMH model complements the AGS' work on the Geriatric Assessment and Chronic Care Coordination Act (GACCCA). It provides for the same kind of team care that geriatrics health care professionals currently provide their patients.
The Society's objective is to ensure that care coordination, and dementia and/or comprehensive geriatric assessment are explicit components of the PCMH.
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What is the Status of Proposals for the PCMH?
Demonstration Project
Section 204 of the Tax Relief and Health Care Act of 2006 (TRHCA) mandates a demonstration project in up to 8 states to provide targeted, accessible, continuous and coordinated family-centered care to Medicare beneficiaries who are deemed to be high-need. (Patients with multiple chronic or prolonged illnesses that require regular medical monitoring, advising or treatment would be considered high-need.) Planning for the demonstration project is underway at CMS and the agency expects it to be implemented in late 2008 or early 2009.
One of the objectives of the demonstration project is to determine whether PCMH can reduce hospitalizations through better care management of complex and chronic conditions. The demonstration also calls for testing of a bundled payment structure that supports practices of all sizes that are recognized as PCMHs. Legislation mandating the demonstration authorizes incentives, such as reduced deductibles and co-insurance, for beneficiaries who select a physician within a recognized PCMH as their personal physician. It also authorizes non-financial incentives, such as reductions in documentation requirements, for practices that qualify as PCMHs.
CMS has asked the RUC to cost out the medical home demonstration project and a workgroup has been established to develop a recommendation for the full RUCs consideration at its upcoming meeting.
MedPAC Discussions
At its last meeting, MedPAC discussed a recommendation to Congress that would establish a pilot program to provide Medicare beneficiaries with a 'medical home' to direct their care. The proposal would require physicians to competently provide primary care; coordinate services, utilize health care information technology; conduct care management; provide access and communication to patients; and maintain updated records of patients' advance directives, including the care they should receive if they should become incapacitated. The estimated three-year cost for the program is $400 million.
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