A COMMITTEE of the American Medical Association has sent a proposal for payment rates to implement a medical home demonstration project to the Centers for Medicare & Medicaid Services.
The panel’s suggestions include increases for the additional work that physicians will incur in more closely monitoring patients’ ongoing care and related practice expense input recommendations, such as electronic medical record costs and nurse care coordination.
The Medicare Medical Home Demonstration project is set to begin on January 1. The concept will be tried out in rural, urban and underserved areas in as many as eight states, as mandated by Congress through the Tax Relief and Health Care Act of 2006.
The legislation requests that CMS use a committee process to develop a case management fee and valuation. It’s the first time that CMS has been Congressionally mandated to seek outside advice in valuing a Medicare demonstration project, the AMA said.
Interest is growing in the approach, in which a primary care physician provides comprehensive and coordinated patient-centered medical care. The Patient Centered Primary Care Collaborative has more than 100 member organizations, including four large physician groups.
Making its recommendation in mid-May to the CMS was the American Medical Association/Specialty Society Relative Value Scale Update Committee, commonly known as the RUC.
The panel’s report includes increases in relative value units used to calculate physicians’ payment for ongoing assessment of patients.
The RUC also estimated other direct practice expenses, such as for clinical staff time and visits, varying depending on capabilities of the physician practice. It estimated clinical staff time of 49 to 80 minutes per month, based on the range of servoces a practice can provide.
One cost coverage proposal from the RUC calls for covering the purchase of electronic medical records systems. The legislation mandating the medical home project calls for the use of EMR systems.
The RUC suggests that the project cover a variety of hardware and software costs related to the implementation of EMRs, estimating the costs for licensing software, updates and support at more than $11,000 over three years.
“The RUC has demonstrated its support for the medical home demonstration project ... by unanimously approving the recommendation to CMS,” said RUC Chairman William Rich, MD. “The support of the full RUC is a testament to the willingness of physicians from all specialties to support the evolution of primary care and to help primary care physicians provide comprehensive and coordinated patient centered medical care.”