THE AMERICAN ACADEMY OF FAMILY PHYSICIANS and other groups are calling for change to a bill that would establish a demonstration project to measure the ability of patient-centered medical homes to provide medical assistance under the Medicaid program and child health assistance under the State Children’s Health Insurance Program (SCHIP).
The AAFP, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association are looking for a clear and fair definition of a patient-centered medical home, and also to set an appropriate rate for the minimum care management fee.
“What we want to make sure is that they define what a medical home is, appropriately,” said James King, AAFP president. “We are starting to catch how people are thinking about what the concept of what a medical home is, to supply that care. We are doing this together. We are the groups that are going to have to provide those homes, we need to make sure we’re in agreement with what needs to happen.”
Under the proposed Medical Homes Act of 2007 (S. 2376), Medicaid and SCHIP beneficiaries who are without a regular source of care would be assigned to medical homes with primary care physicians who would be responsible for managing and coordinating their care. It would also create local medical management committees to establish standards and measures for patient-centered medical homes and pay participating physician practices a minimum management fee.
The floor for the management fee is currently $2.50 per member per month. The number is modeled from the Community Care of North Carolina program. The AAFP is worried that this will encourage states to charge the minimum regardless of the quality of care.
“We appreciate the fact that the legislation is attempting to set a floor for this necessary payment for care management within the patient-centered medical home, but the bill does not provide the states or the Centers of Medicare and Medicaid Services with guidance for determining how much this fee should be should be,” said Rick Kellerman, AAFP board chairman.
”We don’t know what the right number is exactly – it might have to go up,” King said.
Each state, Kellerman said, should determine the fee based on a recommendation from a value-determination team comprised of representatives from the MS and each of the primary care physician organizations in the state.
The four physician groups have worked with the National Committee for Quality Assurance to develop a single set of standards for the recognition of physician practices as patient-centered medical homes.
“We would suggest that the legislation at least require the local medical management committees to automatically deem a physician practice to be a qualified medical home if it has achieved recognition by the NCQA or other national standard setting organization,” Kellerman said.