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CMS Shelves Medicare Medical Home Demonstration

I just received an email from CMS announcing the latest official word on the Medicare Medical Home Demonstration (MMHD):

10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of House Bill 3200 contains a provision to repeal this demonstration and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.

At this time, CMS believes it would be impractical to pursue clearance of the Medicare Medical Home Demonstration, which has been under review at the Office of Management and Budget, given the pending legislation that would repeal it and replace it with a similar pilot. CMS is moving forward with an Administration-initiated demonstration announced by Secretary Sebelius on September 16, 2009, whereby Medicare would partner with existing multi-payer medical home pilots to improve the delivery of care. This demonstration, titled the Multi-Payer Advanced Primary Care Practice Demonstration, would be implemented in 2010.

What does this mean? As one who has followed the MMHD closely, here are some of my top-of-mind reactions:

  • First, in typical Medicare style, the meaning here is murky and equivocal.  These guys need to learn to speak POE (plain old English).
  • Has CMS recognized that the business model of the MMHD is DOA? As currently structured, the demo cannot possibly meet the noble but unachievable goals of both improving quality and reducing costs.
  • CMS going forward with Sebelius’ multipayer medical home pilots is a VERY GOOD IDEA! One of the early lessons from disease management was that doctors will not deal with 9 different protocols with 9 different IT systems from 9 different payers. Medicare’s joining existing multipayer pilots brings the biggest payer dog in the neighborhood to the table.  This truly is a step toward building regional Accountable Care Organizations.
  • Medicare’s participation in medical home “pilots” makes more sense than experimentation with “demonstrations”. Medicare has always made a distinction between a “pilot” and “demonstration” project.  A demonstration is an experiment, funded for a limited time, with the purpose of testing a promising clinical and/or organizational model; a pilot is the launch of a model that already has proven merit, with prospects for ongoing funding, and high expectations of continuation. Migrating toward a medical home model requires dramatic changes by physician practices, and most doctors are unlikely to participate if prospects for ongoing implementation are low.
  • Finally, does CMS have authority to shelve the MMHD because there is “proposed legislative language” and because“it would be impractical to pursue clearance…”? This is pretty wishy-washy. The MMHD is a mandated demo through legislation passed in December 2006…what’s really going on here?

Your thoughts?

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8 Comments

  1. Vince Kuraitis on October 27, 2009 at 10:34 am

    It's official: Medicare Medical Home Demo shelved… CMS pursuing more promising multipayer pilots http://bit.ly/4EJ0La



  2. Les Masterson on October 27, 2009 at 10:51 am

    RT @VinceKuraitis It's official: Medicare Medical Home Demo shelved… CMS pursuing more promising multipayer pilots http://bit.ly/4EJ0La



  3. Al Lewis on October 27, 2009 at 1:05 pm

    I can’t decihper it either, but as you know, I have conclusively proven that the NC Medicaid PCMH outcomes numbers were essentially made up. While I am agnostic on the more closed models like Group Health’s, anything that reduces CMS’s commitment to the fantasy that this model would work in an open network is welcome news



  4. arthurwlane on October 27, 2009 at 6:57 pm

    CMS Shelves Medicare Medical Home Demonstration (@VinceKuraitis ): http://bit.ly/1utdI5 #caremgmt



  5. arthurwlane on October 27, 2009 at 7:03 pm

    The Guerrilla Approach to the Care Management that Underlies the Patient Centered Medical Home (DMCB): http://bit.ly/1utdI5 #caremgmt



  6. Les Masterson on October 29, 2009 at 11:52 am

    One of the leading experts on CMS' demo projects, @VinceKuraitis, opines on the recent medical home demo/pilot news. — http://bit.ly/3PAZX



  7. Wellescent Health Blog on October 29, 2009 at 2:31 pm

    In my mind, consolidation of the IT and protocols for interacting with the payers is an absolute necessity for reducing costs in any health care delivery model. In an oversimplified equivalent, imagine how successful commerce would be if every bank or credit card company enforced their own way of collecting payment.

    As for pilot programs versus demonstrations, another benefit of pilots is the opportunity to refine before widespread introduction. Those involved in the pilot can provide invaluable feedback to identify problems that would become costly or even insurmountable if allowed to persist into widespread deployment.



  8. Ron Hammerle on October 30, 2009 at 8:24 am

    A “medical home” that cannot follow mobile Americans is not viable. What a great opportunity for a virtual, national clinic or national medical franchise.

    Ron Hammerle, Chairman
    Health Resources, Ltd.
    Tampa, Florida