A national healthcare quality coalition is urging major reforms in the way Medicare, Medicaid and private health insurance plans pay primary care physicians.
“Healthcare leaders from across the country agreed that better methods of paying for primary care are needed in order to prevent illnesses and unnecessary hospitalizations and to help control the growth in healthcare costs,” said Harold D. Miller, president and CEO of the Network for Regional Healthcare Improvement. “Rather than rewarding physicians for how many services they deliver, we should reward them for improving patient outcomes.”
In its new report, "Pay for Innovation or Pay for Standardization: How to Best Support the Patient-Centered Medical Home," the NRHI cautioned that higher payments to primary care practices should be based primarily on whether they improve outcomes for their patients, rather than whether they meet detailed accreditation standards.
The goal of the medical home is for each patient to have an ongoing relationship with a personal primary care physician and a team of healthcare professionals who collectively take responsibility for providing or arranging for the patient’s healthcare needs in a coordinated way.
Produced with support from the Robert Wood Johnson Foundation, the report said a significant cause of increasing healthcare costs and poor healthcare quality is that many primary care services with proven effectiveness are not paid for at all, and others receive inadequate reimbursement.
The report recommends that primary care practices be paid for services such as nurse care managers and physician phone contacts with patients, together with bonuses or penalties based on outcomes such as rates of preventable hospitalizations and emergency room visits. The report recommends that the current system of fees for individual services be replaced with a single, comprehensive payment to cover all the costs of a person’s outpatient care.
Many healthcare reform proposals have recommended higher payments, but only for primary care practices designated as a PCMH. The report urges that before requiring physician practices to meet detailed standards in order to be designated as medical home, additional evaluations should be completed to determine which specific processes and structures produce better outcomes.
“No one yet knows exactly which specific changes in primary care delivery will have the biggest impacts on healthcare quality and control costs, so initiatives to implement the medical home should encourage innovative approaches focused on improving patient care outcomes,” said Michael W. Painter, JD, MD, a senior program officer at the Robert Wood Johnson Foundation. “Moreover, we should encourage and assist small physician practices to participate in medical home initiatives, since that is where the majority of primary care physicians in the nation practice.”
The full set of recommendations is included in NRHI’s report, "From Volume to Value: Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs."