I’ve been critical in the past when CMS has been silent in explaining their thinking, so I’ll start this post by congratulating CMS on sharing a flood of details about the upcoming Medicare Medical Home Demonstration project.
An email from CMS arrived in my inbox this morning at 2 am. That email notified me that they have updated the MMHD homepage . A quick click lead me to 8 new documents containing 155 pages of newly available details on the MMHD.
If you have time to read just ONE document, take a look a this PowerPoint summary of the MMHD — it’s so fresh that it’s dated October 28, 2008.
Based on a quick perusal, here are some highlights about how the MMHD will be structured. To separate fact from opinion, I’ve put brackets [ ] around my commentary:
Tiers: There will be two tiers of medical homes (as opposed to the three tiers contemplated in the [good old boy] AMA RUC methodology). [Tier 2 appears to be geared toward getting physicians to adopt EHRs/HIT and to integrate higher levels of systems and processes to improve patient care and care management. This ties the MMHD to broader federal policy objectives.]
Physician Eligibility: “General internist, family practice, geriatrics, most other specialties.” Sorry ER doctors, you’re not eligible. [What were you guys smoking — ER as medical home??].
Patient Eligibility : at least one chronic condition (86% of Medicare beneficiaries). [This is much broader than past care management demos and broader than suggested in the enabling legislation. Overall I think it’s very positive as 1) physician practices would not be motivated to participate if only a very small percentage of their patients were eligible, and 2) the MMHD takes on a much stronger focus on wellness/prevention/early detection.]
Timeline:
Location and Sample Size
- 8 sites, to be announced in December
- 400 practices
- 2,000 physicians
- 400,000 patients
Application Process:
Practices submit application form (Jan. – Mar. 2009) (under 1 hour to complete application)
Practices submit self-survey tool and documentation of medical home capabilities (Apr. – Nov. 2009) (60–80 hours). [On the plus side, this looks like a thorough process; on the minus side, how many small practices have capabilities/interest to do this?]
Patient enrollment: physicians must enroll eligible patients; both physician and patient must sign medical home agreement.
Care Management Fee: The care management fee will be risk adjusted based on disease burden and predicted future costs to Medicare. [This is probably the most significant newly revealed aspect of the MMHD! The risk adjusted fee of $100.35 per patient per month will provide physicians significant incentives to participate and develop comprehensive care management capabilities. As a reference point, in the Medicare Medicare Health Support demo project, DM companies and health plans were paid care management fees ranging from $80–150 per patient per month.]
Shared Savings: The first 2% of savings are not shared; 80% of savings above the first 2% (minus fees) are shared with participating practices. [This is a highly speculative upside. Doctors, while this potential windfall might look appealing, you might get better odds in Las Vegas.]
Disclaimer — this demo design is not final.
More later….
Vince, thanks for the post, but I can’t believe that no one has commented yet. Too stunned perhaps?
Steve
Ok, I will be the second one for Vince’s blog.
Medical home is another booming business for small practices if there is a free or low-cost eco-IT system, at least for basic functionalitites that can accommodate the Medicare’s requirement (PHR, PHI, EMR, etc).
Here is the challenge: Medicare-CCHIT’s requirement…… There is no CCHIT’s EMR that can be low-cost or free to meet Medical Home’s requirements.
Ok, let’s take Vista from the VA as an example. $50.00 for the software (I can show you how). Well, even the expert in IT cannot make it run sufficiently . Let’s try to hire a third party vendor. The cost is still tremendous. Ok, got to run for an ER’s pt. I will come back for more. LCN.