Congressional termination of Medicare bonuses under the Affordable Care Act and cuts to Medicaid physician payments in some states have made it increasingly difficult for patient-centered medical homes (PCMHs) to operate in a viable manner, according to an opinion piece published in JAMA Internal Medicine.

Edward Bujold, MD, from the Granite Falls Family Medical Care Center in North Carolina, wrote that while some private insurers offer a 30% payment increase to practices that have achieved the National Committee for Quality Assurance’s Level 3 PCMH recognition, many patients can no longer afford the high premiums associated with traditional healthcare insurance, thus cuting back on this potential revenue stream.

Yet, research demonstrates that for every dollar spent for primary care, $13 is saved in the overall healthcare system. Dr Bujold points out that patients’ use of PCMHs can reduce hospitalizations substantially. However, although this saves the overall healthcare system money, many physicians derive a significant percentage of their income from hospital visits. The current reimbursement model fails to offset this loss of income, and this loss is exacerbated when combined with the termination of Medicare bonuses and cuts in Medicaid payments.

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Dr Bujold suggests that PCMHs could benefit from facility fees, such as those currently charged by hospitals, or from per-member per-month fees to support the infrastructure costs associated with high-quality medical homes. But engaging payer interest is crucial. Payers must be persuaded to support PCMH transformation, and states should be encouraged to engage physician practices or work with Medicare to support the transformation.

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Bjuold E. The impending death of the patient-centered medical home [published online September 25, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.4651