Medical Home Pilots Boost Physician Incomes and Image

According to the Patient Centered Primary Care Collaborative, there are nearly two dozen medical home pilot projects or demonstrations currently underway around the country. None of them are identical. One pilot reimburses physicians using a comprehensive care payment format, another retains a fee-for-service model but adds on a care coordination payment to reward physicians for an extra level of service. Some work better for large groups, others are better suited for rural areas.

But, one of the elements they all seem to have in common is the opportunity to boost a practice’s income.

“I don’t think any of us would be getting into this if we didn’t believe we could be more efficient,” says James J. Dearing, DO, an osteopathic family physician practicing in Phoenix and a participant in a UnitedHealthcare medical home pilot. “And by being more efficient, we could be more profitable.”

Righting the wrongs

Jose Guethon, MD, MBA, president and chief operating officer for MetCare, which is currently running a medical home pilot in its nine wholly owned offices in south and central Florida, says that what happens too often in healthcare today is that physicians are paid to see more patients. “I’ve got to see more patients and do more things to them to generate revenue,” Guethon explains. “But that is what has caused our crisis in healthcare. What we really should be doing is rewarding physicians who take the time to make sure the patient gets the care that they need.”

And that’s the main concept behind the medical home pilots—the restructuring of the way care is delivered; where primary care physicians lead and work with a team that includes nurses, medical assistants, and dieticians. According to Bruce Nash, MD, MBA, chief medical officer at Albany, New York-based CDPHP, a physician-founded health plan in the midst of a 30-month pilot, the restructuring allows physicians to do more of what they were trained to do. “They’re using their cognitive skills for diagnosis and management, not trying to maximize the volume in their offices.”

How it works

James Leyhane, MD, an internist with Community Care Physicians in Castleton, New York, is participating in the CDPHP pilot. He explains that as part of the pilot, his practice receives a risk payment averaging $35,000 per provider, with the actual amount dependent on how ill the practice’s patient population is. That amount is annualized but paid on a quarterly basis. “That increases the base salary of the providers,” he says. In addition, a $50,000 bonus is available per provider annually for hitting certain targets, such as quality metrics and patient satisfaction.

For example, Leyhane explains that anywhere from 30% to 50% of urgent care and emergency room visits are based more on convenience than the severity of the illness. A doctor couldn’t see a patient during a given afternoon, so the patient goes to the ER at night. “In this program,” says Leyhane, whose practice has decided that the entire office will share in the bonus money, “if we can arrange to stay later or be more responsible and see that person when it’s convenient for them, then we can save that money, and that puts us more into the bonus territory.”

“With the old system,” Leyhane continues, “if you see a patient five times for their bronchitis before you cure it, you get paid five times as much as the doctor who cures them the first time. You can see where that’s going, and it’s not a good place.”

Indirect benefits

Beyond the bottom line monetary benefits, there are significant secondary or indirect benefits resulting from the way these pilots restructure the way care is delivered. For example, Leyhane explains that if a patient can’t get to the pharmacy to pick up their medication, members of the practice staff will often deliver it to the patient on their way home. “That can make a big difference in compliance,” he says. “Because the patient has a sense that it’s not just the doctor who cares about them, it’s the whole office.”

Guethon echoes those thoughts. “Imagine when that person goes back to church, or down to the barber shop—the word of mouth. We don’t even have to advertise. They’re going to naturally say, ‘You’ve got to come see my doctor. You have to be part of this.’”

Dearing believes that everyone from the White House to the major healthcare payors is looking for a vehicle that will positively enable healthcare reform, and that the patient-centered medical home is the best vehicle currently available. “It’s a vehicle that allows us to be more efficient in the system of medicine. And if you become more efficient in the things you do and the way you do them, there’s no way that you won’t make more money.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes feedback at edwardr@frontiernet.net.