Pcmh?
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A short presentation on Patient Centered Medical Home for Truman Medical Center - Lakewood
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Pcmh?
- 1. PATIENT CENTERED MEDICAL HOME? REALLY? DAVID VORAN, MD A look into the future of Primary Care5/31/2013
- 2. Agenda Reality check: US healthcare Why Patient Centered Medical Homes? What we are now Implications for you
- 3. How does our current system stack up? Reality Check
- 4. Middle to Bottom of the Pack Of 13 countries in recent study … 13th for low-birth weight % 13th for neonatal & infant mortality 11th for postnatal mortality 13th for years of potential life lost 11th for life expectancy @ 1 yrs (females), 12th (males) 10th for life expectancy @ 15 yrs (females ),12th (males) 10th for life expectancy @ 40 yrs (females), 9th (males) 7th for life expectancy @ 65 yrs (females), 7th (males) 3rd for life expectancy @ 80 yrs (females), 3rd (males) 10th for age adjusted mortality Barbara Starflield, MD, MPH. JAMA July 26, 200
- 5. An Outlier by Any Measure
- 7. We can’t afford to continue with our current paradigms Why PCMH?
- 8. Many Programs :: Similar Goals
- 9. In Support of Medical Homes Policies Community Practice Encounter Alignment of Incentives International findings
- 10. Fundamental Concept: Teams Physicians ANPs and Nurses PA’s Pharmacists Nutritionists Social Workers Educators Care Coordinators Comprehensive Requires Teams Team Members Virtual Teams
- 11. What is the PCMH? Clinic that puts patient’s at the center of the health care system Provides primary care Accessible Continuous Comprehensive Family Centered Coordinated Compassionate Culturally effective American Academy of Pediatrics
- 12. Physician Practices Connections© Formally recognize practices that use systemic processes and information technology to enhance the quality of patient care Know and use patient histories Follow up with patients and other providers Manage patient populations and use evidence based care Employ electronic tools to prevent medical errors 9 PPC© standards and 3 levels of recognition
- 13. Joint Principles Provide a personal physician for each patient Physician directed medical practice Oriented around the whole person Coordinated and integrated Care Adhere to quality and safety hallmarks Provide enhanced access Dedicated to payment reform AAFP, ACP, AAP, AOA
- 14. NCQA and PCMH Defined standards with 3-tiered recognition Physician Practice Connections – PCMH program PPC – PCMH recognition Application completion Submit documentation proving processes and policies are in place Levels Basic – Level 1 Intermediate – Level 2 Advanced – Level 3
- 15. 9 PPC-PCMH Standards (7 must pass) Standards Must Pass Elements 1) Access and Communication Written patient access and communication standards Use data showing standards are met 2) Patient tracking and Registry Clinical information organized in paper or electronic tools Data used to identify diagnoses and conditions 3) Care management Adopt and implement evidence based guidelines in 3 conditions 4) Patient self-management support Support patient self-management 5) Electronic prescribing 6) Test tracking Track tests & identify abnormals systematically 7) Referral tracking Paper or electronic referral tracking system 8) Performance reporting & improvement Measure clinical and/or service performance by physician Report performance across practice by physician 9) Advanced electronic communications
- 16. PPC – PCMH Content and Scoring
- 17. PPC – PCMH Content and Scoring
- 19. Most PCMH sites are level 3 Sites Recognized as of 4-30-2013 5,660 PCMH sites (27, 328 physicians) Most in NY, NC, PA *Over 230,000 physician practices in US 830 549 4,281 - 1,000 2,000 3,000 4,000 5,000 Level 1 Level 2 Level 3 Courtesy of Bilaf Javed, Data Analyst, Physicain Recognition Programs, N 0 200 400 600 800 1000 1200 Mil AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
- 20. PCMH and MU Alignment
- 21. Story Gets Complicated Physician FTE/yr PPM Patient Tracking $27,300 $1.06 Quality Improvement $32,731 $1.86 Access/Communication ($39,809) JAMA 308(1), pp 60-66
- 23. Recognition not always meaningful Assure adequate financial resources Tailor approach to each practice Assist physicians with personal transformation NCQA needs to modify its PCMH-Recognition Process
- 24. Middle of the road to recognition Where we are now
- 25. Where we are now
- 26. Where we are now
- 27. Where we are now
- 28. Where we are now
- 29. Where we are now
- 30. Where we are now
- 31. Change is hard work … you’ll probably be doing something different than for which you’re now being trained Implications For You
- 32. Doing it right requires changes Requires transformation Means personal transformation of physicians Developmental Local Required technology is not Plug and Play Change Fatigue is a big problem Annals of Family Medicin
- 33. At the heart of all programs Inexorable shift from individual to population care Reduction of the cost burden of health care Transparent and open access to information
- 34. Payers should largely eliminate stand-alone fee-for-service payments Transition to a quality and value based system and adopted with broad adoption by the end of the decade Continue recalibrating fee-for-service payments to encourage…cost effectiveness and penalize behavior that misuses or overuses care Annual updates should be increased for E&M and freeze procedural diagnosis codes for a period of three years Eliminate higher payment for facility-based services that can be performed in a lower-cost setting Fee-for-service contracts should always incorporate quality metrics Fee-for-service reimbursement should encourage small practices (< 5 providers) to form virtual relationships Fixed payments should initially focus on areas where significant potential exists for cost savings and higher quality Measures to safeguard access to care, adequacy of risk- adjustment indicators, and promote strong physician commitment to patients should be put into place for fixed payment models Eliminate the Sustainable Growth Rate Pay for SGR repeal from Medicare cost savings Relative Value Scale Update Committee (RUC) should make decision-making more transparent and diversify its membership.
- 35. What You Might Experience Patients come to you Serial work flow Treat individual Work related reimbursement Patient a passive recipient of care 9-5 M-F You bring patients in Parallel work flow Treat a population Quality based reimbursement Patient an active participant 24x7x365 Current Future
- 36. Real Patient Centered Care “Gimme my damn data” “My Mom is my Medical Home” About me, after all I’m the patient Let me “in” and be a user of the system Where I go for medical care Need to take me 24x7x365 Easy access to all of my medical information Care for most problems without referrals Person answering phone, e-mails, etc. Treating me at home whenever possible
Notas do Editor
- No matter what measure US is an outlier
- Not getting value for money spent
- All of these programs have common elementsWHP – Wellness and Health Plan PromotionACO – Accountable Care OrganizationPCMH – Patient Centered Medical HomePPC – Physician Practice ConnectionsSPM – Society for Participatory Medicine
- But applies to networksConclusionGroup Health’s experience in a prototype clinic suggests that primary care enhancements, in the form of the medical home, hold promise for controlling costs, improving quality, and better meeting the needs of patients and care teams. We offer an operational blueprint, but success in other settings will depend on leadership, resourcing, electronic health records, change management, and aligned incentives. Primary care transformation represents a complex system redesign that requires a policy environment that aligns payment and training to support this work. It also requires organizations in which leaders, managers, and care providers are highly engaged in achieving this change. ▪
- Bilal JavedData Analyst, Physician Recognition ProgramsNational Committee for Quality Assurance (NCQA)1100 13th Street N.W. Suite 1000Washington, DC 20005Ph: (202) 955-3503Fax: (202) 955-3599Email: javed@ncqa.org
- http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/2012-03-27_series_pcmh-mu.pdf
- "Association between patient-centered medical home rating and operating cost at Federally-funded health centers," by Robert S. Nocon, M.H.S., Ravi Sharma, Ph.D., Jonathan M. Birnberg, M.D., M.S., and others in the July 4, 2012, Journal of the American Medical Association 308(1), pp. 60-66http://www.uchospitals.edu/news/2012/20120624-pcmh.html
- We have already learned enough from the NDP to identify some potentially dangerous red flags fluttering over the demonstrations just getting underway. Our early analysis raises concerns that current demonstration designs seriously underestimate the magnitude and time frame for the required changes, overestimate the readiness and expectations of information technology, and are seriously undercapitalized. We fear that with current assumptions, many demonstrations place participating practices at substantial risk and may jeopardize the evolution of the PCMH as unrealistic expectations set up demonstrations and evaluations for failure. The lessons described below arise from both the real-time or “live” qualitative analysis conducted during the NDP and the in-depth and comprehensive analysis currently underway. The live analysis included realtime reading of all data and multidisciplinary analysis team discussion in biweekly conference calls, quarterly reports to the NDP board,18 site visits by a member of the evaluation team, 3 analytic retreats, and member checking with NDP facilitators and practice participants to both expand understanding and seek disconfirming data. This special report, based on our ongoing analysis, raises timely concerns and opportunities. The pressure toward widespread adoption of this is model is gaining momentum so rapidly that we feel compelled to share our observations and summarize the early process-evaluation lessons. We describe 6 critical lessons, suggest 4 recommendations for health policy and 4 for practices, and raise hopeful warnings at this critical juncture for primary care reform.
- Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical HomePaul A. Nutting, MD, MSPH, William L. Miller, MD, MA, [...], and Kurt C. Stange, MD, PhD Ann Fam Med. 2010 May; 8(Suppl 1): S57–S67.
- Steven A. Schroeder, MD and William Frist, MD for the National Commission on Physician Payment Reform, “Phasing Out Fee-for-Service Payment.” New England Journal of Medicine 368;21:2029-2032http://physicianpaymentcommission.org/wp-content/uploads/2013/03/physician_payment_report.pdf