Life After SGR: Medical Home Concept Looms Larger

"If you are not in a patient-centered medical home (PCMH) now, you should be thinking about one."

That was Robert B. Doherty's advice for physicians practicing in the post-SGR world. Doherty, who is senior vice president of government affairs and public policy at the American College of Physicians, shared his views during an ACP press briefing here.

Doherty's support of the PCMH is not surprising since the ACP has championed the concept for decades and succeeded in having it included in the Balanced Budget Act of 1997, the same bill that gave medicine the sustainable growth rate (SGR).

But what long seemed a good concept is now poised to put money in physicians' pockets in the post-SGR era. The reason for that is that the legislation that repealed SGR -- the Medicare Access and CHIP Reauthorization Act -- grants a sort of "most favored nation" status to PCMH.

The law now will require physicians to chose one of two payment models starting in 4.5 years. One is called merit-based incentive payment system or MIPS and the other is alternative payment model or APM.

A physician who selects MIPS is staying within the familiar fee-for-service territory but the payments will be value-based with CMS judging value based on a new set of metrics. Those who deliver the best "value" will reap the greatest rewards (payment). But the "fees" will go up or down based on those new reporting metrics.

Physicians who select APM will also be subject to value-based metrics, clinical practice improvement scores, but if one is practicing in a certified PCMH, "right away you are guaranteed the highest possible clinical improvement score," which represents 15% of the total value score.