The APA Practice Organization Expresses Concerns about Medical Home Demo Expansion
by Government Relations Staff
July 1, 2008—The Centers for Medicare and Medicaid Services (CMS) will begin a new demonstration project in January 2009 to provide high-need beneficiaries with targeted, accessible, continuous and coordinated care under the direction of a personal physician. The American Psychological Association (APA) and other non-physician organizations have expressed the concerns that this project should not extend only to physicians and should not be serve as a gatekeeper by requiring physician referral for specialty services. While recognizing the importance of continuous primary care, APA is closely monitoring the demonstration project to ensure that it does not create an obstacle for beneficiaries seeking access to psychological services.
The demonstration project, instituted under the Tax Relief and Health Care Act of 2006, introduces a concept known as the "medical home" to improve patient care coordination and reduce Medicare costs. The intent of the medical home is that Medicare beneficiaries with multiple chronic illnesses have an ongoing relationship with a personal physician who can coordinate comprehensive health care services as well as support, oversight and coordination of care.
While the original legislation called for the demonstration project to include urban, rural and underserved areas in no more than eight states, the recently proposed Senate Medicare bill would expand the demonstration project. APA joined with nine other non-physician organizations on the attached letter to Senators Baucus and Grassley asking that the medical home demonstration not be limited to physicians and that it not be expanded until the results of the initial project could be analyzed. The letter also asked for language in the Congressional Record verifying that the personal physician in a medical home was not intended to serve as a gatekeeper and that Medicare beneficiaries would continue to have unrestricted access to specialty services.
Under the medical home model, primary care physicians provide case management services to patients with multiple chronic conditions that require medical monitoring, advising, and/or treatment. The personal physician would receive a per capita fee as well as payment for office visits. A medical group practice can operate as a medical home, with the patient's personal physician leading a team that collectively has responsibility for the patient's care. This includes all types of care: acute, chronic, preventive and ultimately end-of-life care.
The APA Practice Organization, along with other non-physician provider associations, sent the following letter to the Senate Finance Committee leadership expressing concern about expansion of the medical home model demonstration project in the Medicare program.
The Honorable Max Baucus Chairman
Senate Finance Committee
219 Dirksen Senate Office Building Washington, DC 20510
The Honorable Charles Grassley Ranking Member
Senate Finance Committee
219 Dirksen Senate Office Building Washington, DC 20510
Dear Chairman Baucus and Senator Grassley:
The undersigned organizations look forward to working with you in the development and passage of a Medicare package to avoid payment cuts to health care professionals that will go into effect on July 1, 2008. We also understand you are working on a variety of other initiatives to hopefully improve beneficiary access to quality care. We would like to provide some comments on one initiative in particular - the medical home model demonstration project.
As you know, the medical home demonstration project was enacted in 2006 as an eight site demonstration. While our organizations had concerns at the time this demonstration was enacted, we realized it was a limited demonstration. However, we are very concerned that even before the demonstration can be initiated in January 2009 that the Congress would seek to expand the demonstration dramatically to some 500 sites. We would respectfully encourage the Congress not to expand the medical home demonstration at this time, but allow the existing demonstration to go forward to determine if it actually can achieve the goals of improving patient care coordination and decreasing utilization and costs within the Medicare program.
We would respectfully make two recommendations in regards to the medical home demonstration project:
First, the demonstration project should not be exclusive to physicians. It must include all health care professionals that provide primary care services to beneficiaries. To limit the demonstration to physicians would be to undermine the demonstration given that so much of primary care received in the U.S. today, particularly in rural and urban underserved areas, is not actually provided by physicians.
Second, we would encourage the inclusion of language to ensure that this medical home model is not simply utilized as a way to funnel health services to facilities owned and operated by physicians for financial gain. To ensure that care coordination occurs and patient access and choice is not jeopardized, we suggest that the following report language be included to accompany any "medical home" provisions in the Medicare package this year. This language will help clarify the intent of the medical home model and guarantee that beneficiaries have optimal choice in the care they receive.
RECOMMENDED REPORT LANGUAGE:
"The medical home must not restrict a patient's freedom to access a health care provider of choice according to Medicare's regulations. The medical home concept is just a way for coordinating knowledge of all the provider care a patient receives through a single medical home, without the need for prior authorizations for such care. Efectively implemented, the medical home can improve health care coordination and advise the patient on quality health care options."
We appreciate your consideration of our comments and of this recommended language. We look forward to working with the Senate Finance Committee as further dialogue and deliberations occur, and offer our services to be a resource to you and your staff.
Sincerely,
American Academy of Audiology
American Academy of Nurse Practitioners
American Chiropractic Association
American College of Nurse-Midwives
American Occupational Therapy Association
American Optometric Association
American Physical Therapy Association
American Podiatric Medical Association
American Psychological Association
National Association of Social Workers
Medical Home Ltr 2008-05-23.pdf
(13.63 Kb)
