Provided by: Jennifer Kirschenbaum, Esq.
April 28, 2011
CMS has implemented a number of initiatives driven at creating models whereby physicians will be paid a percentage of “shared savings”. One such model is the CMS Shared Savings “Medical Home”.
A Medical Home is a physician-based practice that is capable of providing comprehensive ongoing coordination of care to its patients.
To qualify as a Medical Home a medical practice must be organized under the direction of a physician who is board-certified and provides first contact and continuous care for individuals under his or her care. A personal physician could be a family practitioner, geriatrician, or internist, or could practice as a specialist or sub specialist. In addition, the practice must document having specific core capabilities that enable the personal physician to coordinate all of the patient’s medical needs, as set forth by Medicare. For more information about the model component requirements read Design of the CMS Medical Home Demonstration by Mathematica Policy Research, Inc.
Benefit for Qualifying - For those Medical Homes that meet the requirements established by Medicare to qualify as an approved Medical Home, they will be authorized to receive, in addition to fee-for-service, monthly stipends per beneficiary and share in the savings Medicare receives above established threshold levels.
Demonstration Program - Medicare initiated a demonstration program for Medical Homes in 2008. Results are expected to be received in the next year or so regarding shared savings and quality of care measures.
Background on Medical Homes - The concept of a Medical Home was introduced in a 1992 policy statement drafted by the American Academy of Pediatrics (AAP), wherein the AAP identified the need for all children to have accessible, family-centered, continuous, comprehensive, coordinated and culturally effective care. Other professional and specialty and subspecialty groups, including the American Medical Association, American Academy of Family Practice (AAFP), the American Geriatrics Society, the American Osteopathic Association (AOA), the AIDS Healthcare Foundation, and the American Heart Association have also endorsed the Medical Home model for the provision and payment for chronic care in their position statement:Joint Principles of the Patient-Centered Medical Home, (March, 2007), which calls for a physician-directed medical practice with a personal physician providing continuous and comprehensive care across all elements of the complex health care system, utilizing a whole person orientation.
For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at Jennifer@Kirschenbaumesq.com.
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