While the term “Patient Centered Medical Home” may not resonate with the lay public, it has become increasingly understood by Primary Care Physicians to mean an organizational restructuring to maximize Per Member Per Month revenue. In 2017, this model of care will become increasingly understood and adopted by Specialty Practices as they seek to maximize Medicare Revenue and avoid penalties under the Medicare Access and CHIP Reauthorization
To date, most of the strategies to increase the number of Patient Centered Medical Homes have been focused on Primary Care Practices. However, performance and payment adjustments under MACRA’s Merit Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) will now apply to both Primary Care and Specialty Practices where each can earn additional points by achieving Patient Centered Medical Home Recognition.
If oxygenated blood is essential for sustaining life, patient referrals from Primary Care Physicians are the lifeblood of Cardiology Specialty Practices. Yet, other than providing clinical support for the PCP Cardiology Patient, the Cardiology Practice does not impact the patient revenue volume of the PCP…all of that is about to change for innovative Cardiologist.
While some the requirements for 2014 NCQA Primary Care and Specialty Medical Homes differ, one Standard has been the most challenging for PCPs to achieve, Standard 5B- Referral Tracking and Follow-Up, a Must Pass. The reason most often cited for this difficulty is that Specialists do not feel a sense of urgency to return clinical information to the PCP. This leaves the PCP in a difficult position as it relates to achieving PCMH recognition and earning more PMPM revenue.
Based on the principles of Blue Ocean Strategies and Michael Porter's strategic guidance, innovative Cardiology Practices could use MACRA to earn more referrals by achieving Medical Home Recognition as they will have to demonstrate the ability to provide Test Tracking and Follow-Up to and from PCPs as required by NCQA PCMH Standard 5A, a Must Pass.
Early adopters will also enjoy market leverage over competition by demonstrating to the PCP community a commitment to not only provide the best cardiovascular care, but do so in a manner that helps PCPs maximize their PMPM revenue. This also gives early Cardiology adopters an opportunity to increase their referral base by providing the PCPs with something of value without violating any ethical or legal statues. In addition, early adopters will also have a unique ability to provide PCPs with the kind of data they are asked submit under Standard 6: Measure Patient/Family Experience where the CG CAHPS instrument is used to collect, analyze and operationalize Patient Satisfaction data to be published internally and externally.
So, to answer the question, Primary Care Practices need innovative Cardiology and Specialty Practice Medical Homes that demonstrate a similar investment in time and resources that PCPs have to make for PCMH Recognition in order to maximize their PMPM revenue and Medicare reimbursements under MACRA. With a market-driven innovative PCMH strategy, early Cardiology adopters can create an uncontested “Blue Ocean” market position while leaving their competition swimming in a “Red Ocean” where they are irrelevant and harmless.
About the Author:
Dr. Young is a Certified Professional in Healthcare Quality and NCQA Patient Centered Medical Home Content Expert. He is an Assistant Professor of Healthcare and Business Administration and serves as Associate Department Chair of the Donald W. Maine College of Business, Davenport University. He can be reached at firstname.lastname@example.org.
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