November 2, 2009
Vol. II, No. 13
CMS Shelves Plans for Medicare Medical Home Demo in Favor of Multi-Payor Pilots
Citing pending legislation that would repeal its planned Medicare Medical Home demo and replace it with a similar pilot, CMS last week said it would not pursue clearance of the demo from its Office of Management and Budget. Instead, CMS said it will move forward with a demo announced in September by the HHS in which Medicare would partner with existing multi-payor medical home pilots to improve the delivery of care. That Multi-Payor Advanced Primary Care Practice Demonstration will be launched in 2010.
CMS was referring to the pending House Bill 3200, which contains a provision to repeal the CMS demo and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.
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With the exception of health IT costs, a Commonwealth Fund analysis of cost estimates for the medical home model did not find evidence of additional costs associated with higher levels of "medical homeness." The new analysis uses data from 35 practices to analyze the relationship, if any, between costs and medical home activities.
Based on data from the 35 practices in the final analysis sample, researchers found no evidence of additional costs associated with higher levels of medical home activity; estimates suggested that there was less than a $1-per-month difference in patient costs between the third of study practices with the highest PPC®-PCMH™ scores (NCQA rating that measures medical home intensity) and those in the middle and lower thirds. The average total cost per full-time-equivalent (FTE) physician was $517,000 for all 35 practices. Although the mean total cost per FTE physician increased slightly across the three score categories, the low and high means were within one standard error of one another, meaning that the differences were not statistically significant. Support staff costs exhibited a similar pattern.
The report noted that IT costs show a modest but statistically significant increase with medical home intensity and acknowledged that the general lack of an association between costs and medical home intensity may be due to limitations of the data or to the definition of medical home.
The cost data came from the Medical Group Management Association (MGMA) Cost Survey and the American College of Physicians (ACP) Practice Management Check-up Tool for 2006; the medical home data were from NCQA’s PPC-PCMH recognition tool.
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Primary care plays a pivotal role in the reduction of hospital readmissions, especially for older patients with chronic conditions. The posting of hospital readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your strategies by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.
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Healthcare Trends Update: 2009 Telehealth & Telemedicine Benchmarks
While rising healthcare costs fuel much of the healthcare reform debate, many health organizations have tuned in to telehealth to deliver care more efficiently while expanding access to services — especially for patients in rural areas. Download this complimentary summary of the 2009 Telehealth & Telemedicine Benchmarks e-survey, which identifies emerging trends and metrics in telehealth use and its effect on care delivery, healthcare access and healthcare spend through an analysis of responses from 139 healthcare organizations.
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