How Medical Home Recognition Can Impact Reimbursement
The medical home model is becoming widely recognized as an effective method of enhancing quality of patient care and, in turn, improving patient outcomes for primary care practices. Ultimately, such quality improvement will be tied to reimbursement under value-based reimbursement models, such as CMS' value-based payment modifier program, which is set to begin in 2015 for select physicians and will impact all physicians by 2017. But adopting this model and pursuing recognition or accreditation as a medical home can also benefit your bottom line right now.
Differential payments are arising in many states to support the PCMH delivery model. Check out the table below to see how PCMH status is impacting health care reimbursement in a number of states.
|CO||$4.00 to $8.50||Additional PMPM payment|
||Additional PMPM payment based upon PCMH Level|
|MN||$10.14 to $60.81 PMPM||Additional PMPM payment based on number of chronic conditions; Commercial insurance required to offer PCMH Models to insured patients|
|NY||$35,000 Bonus – year 1
$50,000 Bonus – year 2
Plus $1.67-$2.50 PMPM
|Year 1 bonus for PCMH accepting panel patients; Year 2 bonus based on achieving performance metrics|
|OK||$3.03 to $8.69 PMPM||Additional PMPM Payment|
|PA||$0.60 to $7.00 PMPM||Also eligible for shared savings based on performance|
|RI||$3.00 PMPM||Additional $1.16 PMPM available for nurse care manager payment|
|TN||BCBSTN Up to $50K Grants||Also, paying salary of embedded nurse care manager|
|VT||$1.20 to $2.39 PMPM||Additional PMPM Payment|
|WA||$2.00 to $2.50 PMPM||Also eligible for shared savings based on performance|
For more information, view archived webinars on topics such as "Patient-Centered Medical Home: The Call to Action" and "Value-Based Purchasing – Physician Performance Measurement and Reimbursement."