Posts Tagged ‘medical home’

Primary Care Gets a Break

Tuesday, July 30th, 2013

There’s no question that primary-care physicians have long been spurned by the fee-for-service model that doesn’t recognize or reimburse fully the time spent with patients. Well, internists had a pretty good summer. Firstly , the CMS “proposed creating new evaluation-and-management codes for non face-to-face activities relating to the coordination of care for patients with two or more chronic conditions”.  And, now a bipartisan draft bill from the House Energy and Commerce Committee’s health subcommittee extends that to care coordination between multiple physicians and other suppliers and providers of services.The number of chronic patients is expected to rise to 171m by 2030.
The CMS proposal solicited public comment on whether general third-party designation of a practice as a medical home could be considered evidence that the practice was up to the task of providing care-coordination services. But the draft of the House bill specifically mentions the National Committee for Quality Assurance’s (NCQA) medical home and patient-centered specialty practice recognition programs.

Part of the solution is to recognize practices as medical homes so they qualify under the new payment model.  Thus far, the NCQA program has designated 5,770 practices as medical homes.

“We are particularly pleased the draft includes expedited recognition of patient-centered medical homes as an approved alternative payment model for medical practices,” Dr. Jeffrey Cain, AAFP president of The American Academy of Family Physicians, said. That said, Cain did add that family doctors are “disappointed that the subcommittee’s draft does not include a provision to specify a higher base-payment rate for those services provided by primary-care physicians,” Cain said.

Primary care has long been affected by dwindling reimbursements — In the 20th annual Modern Healthcare Physician Compensation Survey, family physicians finished last among the 23 specialties tracked – and a consequent migration of family physicians towards hospital employment. Medical students are increasingly avoiding family medicine (the number of students selecting careers in primary care has declined by 41% in the last decade), leading to an expected shortage of 44,000 primary care physicians by 2025.

Healthy San Francisco Covers the City’s Uninsured

Wednesday, July 21st, 2010

Healthy San Francisco, the innovative program that provides affordable healthcare services to an estimated 53,000 uninsured, was given the green light when the Supreme Court turned down a business group’s challenge.  The Supreme Court decision “is a victory for the 53,0000 San Franciscans who have healthcare today through our groundbreaking universal healthcare program,” said Mayor Gavin Newsom, who spearheaded the program.  “The high court’s decision…ensures we can continue providing healthcare coverage to thousands who otherwise would go without.”Healthy San Francisco covers 53,000 citizens who lack healthcare insurance.

Healthy San Francisco won unanimous approval from the city’s Board of Supervisors in 2006 and went into effect on January 1, 2008.  The law requires businesses with 20 or more workers to provide a certain degree of healthcare coverage for their employees.  Alternatively, they can pay a fixed amount into a city healthcare pool for every hour the uninsured employee works.  The Golden Gate Restaurant Association sued to overturn the law, claiming that the city could not legally force businesses to provide health benefits to its workers or participate in the city pool.  The Ninth U.S. Circuit Court of Appeals rejected that argument, as did the Supreme Court.

Healthy San Francisco provides a safety net to the city’s adults who have lacked healthcare insurance for 90 days.  It provides access to a network of hospitals and public and private clinics that provide low- or no-cost-care.  Tangerine Brigham, the program’s director, notes that “So far, about 1,100 employers have selected Healthy San Francisco as their option.”  Because participants are given a personal physician, expensive ER visits to San Francisco General Hospital fell 27 percent in the first years of the program.  A 2009 study by the Kaiser Family Foundation determined that 94 percent of participants were satisfied with Healthy San Francisco.