Medical Home Pros and Cons for Small Practices

Internist Michael Soppet, MD, part of an eight-physician internal medicine practice in Dothan, Alabama, achieved recognition as a patient-centered medical home (PCMH) in 2011. Recently, however, he and his partners opted not to apply for renewal.

The practice could no longer afford to fulfill all the requirements of a PCMH and go through the time-intensive recognition-renewal process after a major payer dropped its care management fee, says Soppet. Previously, the practice had been receiving a per-member-per-month fee in addition to enhanced fee-for-service payments under a Blue Cross Blue Shield of Alabama PCMH pilot project.

Like many physicians, Soppet and his partners embrace the principles of the PCMH but struggle to make it work in a fee-for-service environment. However, the Medicare Quality Payment Program—part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—may offer an alternative for Soppet and others. The program, slated to start in January, outlines two incentive pathways for practices: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM). 

To sustain a medical home practice, smaller practices should look to participate in the Medicare program or to collaborate with payers that offer financial incentives above and beyond fee-for-service reimbursements, says Yul Ejnes, MD, a general internist with Coastal Medical in Cranston, Rhode Island, who chairs the National Committee for Quality Assurance’s (NCQA) PCMH 2017 Advisory Committee. 

“You can’t run a medical home practice on a purely fee-for-service basis,” he says. “You have to have financial support from payers and look for affiliations with others to share costs.”