Becoming a Medical Home Can Boost Reimbursement

If your practice is not already recognized as a Patient-Centered Medical Home (PCMH), it may be time to jump on the bandwagon. Susanne Madden, president and CEO of practice-management consulting firm The Verden Group, says more payers are offering higher reimbursement or incentives to practices that have met the recognition criteria.

If you are considering becoming a medical home, Madden recommends approaching your payers to find out your reimbursement options as soon as possible. Some payers will be more transparent than others regarding medical home incentives, so ask directly what your payers are looking for and how your practice can get involved. If you find that a payer is not currently offering such incentives, attempt to negotiate for them, says Madden.

Whatever you do, don't procrastinate on starting the medical-home recognition process, says Madden. As more practices become recognized, those that don't will likely be considered "substandard." When that happens, Madden says, the non-PCMH practices may experience reimbursement cuts. "Ultimately, at some point we're going to hit a tipping point," she says.

An added bonus of achieving recognition as a medical home is that it's a stepping stone to larger value-based payment initiatives, such as accountable care organizations (ACOs) in which various healthcare systems work together to improve care quality while reducing care costs.

"In an ACO there's a lot of accountability, there's a lot of care coordination, there really is a whole idea of holding the line on costs," says Madden. "So PCMH or PCSP [a Patient-Centered Specialty Practice] for the specialists, really helps you sort of streamline your practice into being able to participate effectively in an ACO."

Recognition as a medical home may also give you more leverage if you are approached by another healthcare system about joining its ACO, says Madden. Since your practice will have already embraced many of the strategies that will make it successful within an ACO, the potential ACO partners may be more willing to provide you with a favorable partnership arrangement.

This article originally appeared in the February 2015 issue of Physicians Practice.