In tthe L
Literraturre
Highlights
H
from
m Commonwealtth Fund-Supporrted Studies in P
Professional Jo
ournals
............................................................................................................ ...............................................................................
AssocciationBetwee
enPatie
ent‐Cen
nteredM
MedicallHome
Ratin
ngandO
Operatin
ngCosttatFede
erallyF
FundedHealth
h
Cente
ers
............................................................................................................ ...............................................................................
Authors: Ro
obert S. Nocon, M.H.S.,
M
Ravi Sh
harma, Ph.D., Jon
nathan M. Birnbberg, M.D., M.S.., Quyen Ngo-M
Metzger, M.D., M
M.P.H.,
Sang Mee Lee,
L Ph.D., and Marshall
M
H. Chin
n, M.D., M.P.H..
Journal: Jou
urnal of the Ameerican Medical Association,
A
publlished online Junne 24, 2012
Contact: Ro
obert S. Nocon, M.H.S.,
M
Departm
ment of Medicinee, University of C
d.uchicago.edu, o
or
Chicago, rnoconn@medicine.bsd
Mary Maho
on, Assistant Vicee President, Pub
blic Information, The Commonw
wealth Fund, mm
m@cmwf.org
Access to fu
ull article: http://jama.jamanetworrk.com/article.aspx?articleid=11997012
............................................................................................................ ...............................................................................
Synopsis
A study of
o federally funded
f
health
h centers fou
und that thosse that have a greater nu
umber of attriibutes
associated
d with a patiient-centered medical hom
me also had higher operrating costs. Although medical
homes haave the poten
ntial to impro
ove quality off care and sllow the grow
wth in overalll health care costs,
primary care
c
paymentt must reflect the increased
d costs assocciated with thhe medical ho
ome to ensurre that
this care delivery
d
modeel can be susttained.
............................................................................................................ ..............................................................................
The Issuee
With earlly evidence showing thaat patient-cen
ntered mediccal homes
“Paymen
nt for the me
edical
(PCMHs) can improvve access to high-qualityy primary caare, many
home sho
ould be evide
encehealth carre leaders arre calling forr widespread adoption off this care
based a
and ground
ded
delivery model.
m
To make
m
informeed decisions when implem
menting a
in obs
servations of
PCMH, primary
p
care practices mu
ust understand
d the operatiing costs·
costs
s that acc
crue
those relaated to provid
ding round-th
he-clock acceess to care, ppurchasing
to e
each
and main
ntaining electtronic health
h records and clinical innformation
sttakehold
der.”
systems, and
a others. Such
S
data aree also needed
d to design ffinancially
feasible payment policiies for medicaal homes. Wrriting in the Jo
Journal of the American M
Medical Associiation,
wealth Fund
d–supported researchers
r
compared
c
prracticesÊ med
dical home rratings, specifically
Commonw
looking att federally fun
nded health centers, and th
heir operatingg costs.
............................................................................................................ ...............................................................................
Key Find
dings
•
Higheer scores on a scale assessiing six aspectts of PCMHs were associaated with high
her operating costs.
Speciffically, a 10-p
point-higher ovverall PCMH
H score was asssociated withh a $2.26, or 44.6 percent, h
higher
operaating cost per patient per month.
m
•
Two medical home subscales·ability to track patients and capacity to perform quality measurement
and improvement·were associated with greater costs. A 10-point-higher score for patient tracking was
associated with higher operating costs per full-time-equivalent physician ($27,300) and per patient per
month ($1.06). A 10-point-higher score for quality improvement was associated with higher operating
costs per full-time-equivalent physician ($32,731) and per patient per month ($1.86).
•
Access and communication were one aspect associated with lower operating costs. Specifically, a 10point-higher score for access and communication was associated with lower operating costs per fulltime-equivalent physician ($39,809).
.......................................................................................................................................................................................
Addressing the Problem
From health clinicsÊ standpoint, the higher operating costs associated with higher PCMH ratings are
significant. For example, $2.26 in higher operating costs per patient per month translates to $508,207
annually for the average clinic in the study. While such expenses are high for a clinic, they are small
relative to potential savings from better management of patient care in medical homes versus emergency
department use or hospitalization. A 2010 study of an integrated delivery system using PCMHs found
savings of $18 per patient per month from reduced hospitalization and emergency department use. Yet
under most delivery models, such downstream savings would accrue to health care payers, not physician
practices. The authors conclude that financial incentives must be designed to ensure the PCMH modelÊs
sustainability.
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About the Study
The authors assessed the relationship between a practiceÊs medical home rating and its operating costs,
focusing on 669 federally funded health centers. The centers were rated on a 100-point medical home
scale based on findings from the 2009 Commonwealth Fund National Survey of Federally Qualified
Health Centers. The scale measures patientsÊ ability to contact their clinician on a timely basis and
providersÊ ability to secure outside referrals, among other functions. The authors focused on three cost
measures: operating costs per full-time-equivalent physician, operating costs per patient per month, and
medical costs per visit.
.......................................................................................................................................................................................
The Bottom Line
Medical homes may incur higher per-patient operating costs because of their spending on additional
personnel, electronic medical records, and quality improvement measures. To ensure the model can be
sustained, appropriate financial incentives are needed.
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Citation
R. S. Nocon, R. Sharma, J. M. Birnberg et al., „Association Between Patient-Centered Medical Home
Rating and Operating Cost at Federally Funded Health Centers,‰ Journal of the American Medical
Association, published online June 24, 2012.
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This summary was prepared by Martha Hostetter.