Medical Home Projects Look to Increase Pay for PCPs

Denis Chagnon, MD, Latham Medical Group, has been a private practice family physician for 35 years. At age 62, he’s probably seen it all. Part of what he’s seen is that his 2007 take-home income, in real dollars, was less than it was 15 year ago. And unfortunately, Chagnon is not alone. Income to primary care physicians over the last 20 years has gone up, in actual dollars, by just 20 percent, according to Allan Goroll, MD, professor of medicine at Harvard Medical School.

But Chagnon is cautiously optimistic that change is possible. That’s because 2 months ago his practice began participating in a 2-year patient-centered medical home project, launched by physician-founded health plan CDPHP. The project is designed to address the national primary care crisis and transform primary care practice and payment models in New York’s Capital District. It’s one of several such initiatives taking place across the country, and according to primary care physicians, it’s about time.

Change in the wind

CDPHP reports that studies have shown that when health plan members have ready access to primary care—defined as first contact, comprehensive, coordinated, continuous and personalized care—they experience improved health status, lower cost, and more equitable distribution of care. Currently, the fee-for-service reimbursement model erodes that mission by forcing practitioners to see as many patients as possible in order to remain profitable, and it does not compensate doctors for phone calls and paperwork.

“We don’t have the time to do [healthcare] right,” Chagnon says. “We have to see so many patients that we don’t have the time to spend with them to get into the issues that may decrease costs overall.” Those issues include unnecessary MRI scans or end-of-life treatments that could be avoided by spending more time, and communicating more, with patients and their families.

“The concept [with the medical home project] is that in theory, the insurance companies can pay [primary care physicians] more than they currently do, but we can save them so much money that we’d off-set that amount,” says Chagnon.

Community Care Physicians in Schodack, NY, is one of the three practices participating in the CDPHP project. James Leyhane, MD, says the main reason why his practice is involved is that “primary care is dying in America, and we want to try to revive that.”

Leyhane points to Japan, where the cost of delivering healthcare is half that of the U.S., yet primary care physicians are paid on a par with specialists. “There isn’t a disincentive for medical school students to go into primary care,” he explains. “I don’t want to be the generation of physicians that presides over the death of primary care. That’s a terrible legacy.”

The Philadelphia experiment

Richard Baron, MD, of Greenhouse Internists, is one of 100-plus physicians in metropolitan Philadelphia taking part in a similar project being jointly conducted by some of the area’s largest insurers. The 3-year project will use measurement tools developed by NCQA to assess whether physician practices meet certain health and outcomes standards, including patient satisfaction, quality and cost, with the potential for each doctor in his practice to earn as much as $60,000 additional based on the standards met.

“We positioned ourselves well to do this kind of work because we adopted an electronic health record four years ago,” says Baron. “I think that’s essential to be able to do this kind of work. It allows you to move information around, develop a team, and get other people engaged in helping to take care of patients. And it allows you to measure how you’re doing, and identify populations of people who may need certain kinds of care.”

Baron points out that even with the added monetary incentive, turning those funds into patient-centered care is challenging. It involves developing new protocols and retraining staff. His practice has hired a patient educator to help develop tools to more reliably and consistently engage patients in treatment plans. “With chronic disease, there are a lot of things that people believe make a big difference in outcomes, and one of them is doing a better job educating patients about what they need to do,” says Baron. “Right now, we don’t do a good job of providing written information consistently.”

Change is paramount

Goroll, one of four industry experts who are assisting participants in the CDPHP project, says that real change involves more than just added monies changing hands. “There has to be a combination of payment reform and practice reform. Just paying your primary care doctor more will not solve the problem. Because primary care, in order to deliver, has to reorganize itself.”

Leyhane agrees. He says that with the patient-centered medical home model, “We have to save between 2 and 3 percent of total medical costs in order to have enough extra capital to potentially double the primary care salary,” a goal he says is “very doable.” But primary care doctors must be willing to do a little more work for a short period to make the changes necessary to adopt electronics, and adopt a new way of looking at patients as consumers.

“If we don’t,” he says, “the insurance companies and the government are going to kill us. They’ll just turn the wheel faster and faster until you either stop…or collapse.”

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