Reform Update: Specialty physicians make inroads into medical homes

The proposals to scrap Medicare's sustainable growth-rate formula for updating physician pay include less-noticed provisions rewarding practices that operate as a patient-centered medical home. There is a twist, however.

The medical home practice model was developed by primary-care medical societies, and the concept's principles include a “whole person orientation.” So, even though a patient may receive the bulk of their care from a cardiologist or oncologist, that practice—by the primary-care societies' definition—can't be a medical home because of the focus on one organ system or one disease condition.

But it appears that Congress and organizations such as the National Committee for Quality Assurance disagree with the primary-care docs on this one.

“Congress is rapidly advancing Medicare physician payment reform legislation that rewards value over volume for patient-centered medical homes and patient-centeredspecialty practices,” said Margaret O'Kane, NCQA president.

O'Kane noted that the legislation—as well as the 2014 Medicare physician fee schedule—include measures that would reward practices for services typically associated with medical homes such as non-face-to-face care-management services for patients with two or more chronic conditions. 

The NCQA has recognized 6,550 practices as medical homes, and O'Kane said medical homes and patient-centered specialty practices could serve as platforms for “alternative payment models” that move healthcare away from fee for service.

The private sector is moving faster than the government—particularly in the area of financially rewarding oncology practices that operate as medical homes.