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Patient-Centered Care: Primary Care Home and Specialty Medical Neighborhood

As I shared in November on this portal, new MACRA regulations will determine physician payment beginning in 2019 (based on quality and cost experience measured in 2017).  For now, Starling Physicians will be in the MIPS track of MACRA, which means Medicare payments have the potential to fluctuate up and down each year depending upon how our performance compares with other Medicare providers around the country.

As it’s currently conceived, if Starling wishes to participate in the APM (Alternative Payment Model) track, which offers regular fee schedule increases and less volatility, we will need to demonstrate Patient-Centered Medical Home functionality, which includes:

  • Accountability for meeting the large majority of each patient’s physical and mental health care needs using a team approach (physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators and care coordinators)
  • Patient-centered resources that recognize differences in culture, language, values and preferences, and include the patient and family in the care team
  • Coordinating care in all venues, including primary and specialty care, hospital and SNF, home health, community and home-based supports
  • Prompt access for urgent needs, expanding in-person hours, 24/7 telephonic or electronic access to a member of the care team and availability of email and phone responses.

Many of these elements are already in place in our primary care practices, and we will need to continue investing in the additional functionality necessary to become a PCMH.  Even if the specific requirements for the APM track of MACRA change PCMH certification will be extremely helpful, because certified practices automatically earn 100% credit for the Improvement Activities portion of MIPS, which is worth 15% of the total performance score. For more information about Improvement Activities, visit here.

Next time:  If Primary Care is Home, Which Specialists are in the Neighborhood?