How to Buy a Medical Home? Policy Options and Practical Questions

×

Robert Berenson and Eugene Rich explore payment options for patient-centered medical homes (PCMHs) in a special supplement to the Journal of General Internal Medicine. The first option they discuss is enhanced fee-for-service payments for office visits to PCMHs—the "most straightforward" approach administratively, they say, but one that does not directly reward some key primary care activities and limits flexibility. The second option is using fee-for-service payments to reimburse additional PCMH activities. This approach is limited, the authors say, by the challenge of clearly defining certain PCMH activities, like palliative care discussions with patients and families. The third approach, standard fee-for-service reimbursement for office visits and per-member per-month (PMPM) payments for medical homes activities, is most commonly recommended by physician specialty societies. As the authors warn, however, this payment model requires methods for determining whether practices can be considered PCMHs, as well as accounting for PCMH performance. The fourth option is reducing fee-for-service payments for office visits and increasing PMPM payments. This approach could help to reduce fee-for-service incentives for overuse; it is the dominant model in other countries, notably Denmark. The final approach is comprehensive capitation payments for primary care and medical home services. While this method may have advantages, the authors warn that it may suffer the same pitfalls as capitation generally, with consumers equating the PCMH with "gatekeeping."

This research was supported by The Commonwealth Fund, the Agency for Healthcare Research and Quality, and the American Board of Internal Medicine Foundation.

Publication Details

Publication Date:
June 3, 2010
Authors:
Robert Berenson and Eugene Rich
Summary Writer:
Deborah Lorber
Citation:
R. A. Berenson and E. C. Rich, "How to Buy a Medical Home? Policy Options and Practical Questions," Journal of General Internal Medicine, June 2010 25(6):619–24.

Related Topics


Forgot Password

An email has been sent to {{email}} with your reset password.

Account was not found. Please go to the login page and enter a new password.

Account was not found. Please try again with a different email address.

There was an error when attempting to send to {{email}}. Please contact an administrator.