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    PCMH playbook

    7 steps to plan today for a value-based payment future

    Transforming into a PCMH may become a financial safe harbor for many small practices as the government and private payers continue to emphasis value over volume. Starting in 2019, practices that certify as a PCMH will be able to reap the benefits of Medicare’s new alternative payment model program by receiving a 5% pay bonus while avoiding the down-side risk usually associated with value-based payment models such as accountable care organizations.

    “If you are not in a patient-centered medical home (PCMH) now, you should be thinking about one,” Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, said at the organization’s annual conference in May. “If you’re a PCMH, you don’t have to deal with financial risk.”

    Regardless of how PCMH certification affects the bottom line, practices that undertake the process have their work cut out. Small practices in particular often struggle to navigate the complex and time-consuming process with limited resources.

    Related: Becoming a PCMH

    It’s of little surprise then, that substantially fewer physicians in solo practices (6.7%) and small practices (18.9%) reported PCMH certification relative to those in large practices (35.1%) in 2013, according to a Robert Graham Center report. One-third of physicians in solo or smaller practices reported that their practices were considering applying for PCMH certification.

    But even if you don’t have a hospital or large-group infrastructure to help you manage the process, you needn’t go through the journey alone.

    Seek resources

    One of the ways Salvatore S. Volpe’s, MD, New York-based solo primary care practice beat the odds and successfully became a level-3 PCMH was by sending his office manager to a one-day event run by his local regional extension center (REC).

    “They went through all of the elements from NCQA and showed how to provide the evidence to prove the element,” says Volpe, who is a member of the Medical Economics editorial advisory board. “If you’re going to invest the money in a survey tool, software, and a practice transformation, it makes sense to go that one extra step and invest a day or two in hearing from experts what’s the best way to prove it.”

    RECs were a key partner for Ed McBride, MD, vice president of clinical services for Summit Medical Group’s locations in eastern Tennessee. Summit recently applied for its corporate NCQA recertification under the 2014 criteria, with five sites up for renewal.

    “The RECs across the nation are partnering with the Department of Health and Human Services to be the go-to person for their region for things such as meaningful use and PCMH,” McBride says. “If I were not at Summit with access to its resources, I would outreach to my community partners and state-level support.”

     

    NEXT: Do your homework

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