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.
