Get schooled on medical homes, payer reform, and what the future might look like for primary care with Dr. Sue Bornstein, MD, FACP and Executive Director of the Texas Medical Home Initiative and Chair of the Health and Public Policy Committee at the ACP.
Dr Alex Lane of Cooper University Hospital joins Matt as cohost!
Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.
Patient Centered Medical Home
Clinical Pearls:
Major interest groups in healthcare arena: Professional groups (e.g. physicians, nurses), hospitals, pharmaceutical and medical device industries, insurers and consumers/patients. Patient not always at the center due to conflicting interests.
Medical home: a primary care model that is patient-centered, comprehensive, team-based, provides care coordination with enhanced accessibility (e.g. extended hours, electronic visits, telemedicine), and rigorous quality and safety measures.
Caring for chronic illnesses longitudinally is a recent concept. Previously care was “transactional” with doctors caring for acute problems. The old fee-for-service based payment models aren’t well suited for longitudinal care.
Medical homes seem to provide cost savings/benefit for: ambulatory care sensitive conditions like diabetes, congestive heart failure, and asthma; complex patients with high care utilization; and decreased utilization of acute inpatient care
MACRA: the Medicare Access and CHIP Reauthorization Act, is legislation passed in 2015. Replaces previous Medicare reimbursement schedule (fee-for-service) with new pay-for-performance program (aka Quality Payment Program) focused on quality, value, and accountability.
Quality Payment Program:Pay-for-performance model with two tracks: Merit Based Incentive Payment System (MIPS), or Alternate Payment Models (APMs). “You’re a part of the Quality Payment Program in 2017 if you are in an Advanced APM or if you bill Medicare more than $30,000 in Part B allowed charges a year and provide care for more than 100 Medicare patients a year.” -qpp.cms.gov
Alternate Payment Models (APMs): “gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients’ outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.” – qpp.cms.gov
The Affordable Care Act (ACA) attempted to expand Medicaid in all states, however, the Supreme Court threw out the mandate for Medicaid expansion. Payments for disproportionate share hospitals (DSH) were set to decrease under the ACA assuming that Medicaid would be expanded by all states. As of October 1, 2017 payments to DSH will decrease by $43 billion by fiscal year 2025.
Goal: Listeners will be able to discuss the basics players in healthcare and how certain policies will affect doctors, patients, insurers, hospitals, and pharmaceutical/medical device companies
Learning objectives: After listening to this episode listeners will…
Identify the major players (interests) in the healthcare arena and some of their inherent biases
Define MACRA, MIPS, APMs and explain what they mean for physicians
Define Medical Home
Explain why payments to disproportionate share hospitals are in jeopardy
List resources that can help health professionals better understand health policy
Disclosures: Dr Forciea reports no relevant financial disclosures for this episode.
Time Stamps 00:00 Intro 02:42 Guest CV and background 04:42 Getting to know our guest 10:40 Helpful resources for learning health policy 12:10 Who are the major players/influencers in health care and how do their interests align 15:02 Defining “medical home” 18:45 Where did the idea for a “medical home” originate 22:33 How does medical home affect cost 29:45 Payer reform and the quality payment program (QPP) 33:06 Recap and defining terms 37:18 How will the QPP be implemented? 41:04 Repeal and replace 43:37 Cuts in funding for safety net hospitals that care for the poorest, sickest patients 46:59 Take home points 48:55 Outro
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
We and selected third parties use cookies or similar technologies for technical purposes and, with your consent, for other purposes as specified in the cookie policy. Denying consent may make related features unavailable.