An­cil­lary ser­vices grow as re­im­burse­ment in­creases

An­cil­lary busi­nesses emerg­ing as re­im­burse­ment op­por­tu­ni­ties grow

Modern Healthcare - - NEWS - An­dis Robeznieks

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An­dis Robeznieks’ “I’m Not a Doc­tor” blog at mod­ern­health­care.com/not-a-doc­tor

As more pay­ers ap­pear poised to re­im­burse providers for the care-co­or­di­na­tion ser­vices pro­vided un­der the pa­tient-cen­tered med­i­cal home model, other play­ers are step­ping up their med­i­cal home an­cil­lary busi­ness ser­vices.

The Joint Com­mis­sion made the loud­est re­cent splash when it an­nounced Feb. 20 that it would be­gin of­fer­ing the hos­pi­tals it ac­cred­its an ad­di­tional cer­ti­fi­ca­tion as a “pri­mary-care med­i­cal home” to in­sti­tu­tions pro­vid­ing pri­mary-care ser­vices in their out­pa­tient de­part­ments.

Dr. Terry McGeeney, the found­ing pres­i­dent and CEO of Trans­forMED, the Amer­i­can Academy of Fam­ily Physi­cians’ med­i­cal home con­sult­ing sub­sidiary, abruptly stepped down from his post Feb. 8. But be­fore that move, McGeeney wrote a col­umn stat­ing that the health­care in­dus­try is no longer chang­ing—it has changed, and this change will re­sult in win­ners and losers.

Ap­par­ently, he doesn’t be­lieve Trans­forMED will be on the los­ing side, as—in a Dec. 5 in­ter­view on the AAFP web­site—he pre­dicted 300% growth in Trans­forMED’s rev­enue in the cur­rent fis­cal year.

Mean­while, the big­gest player in the med­i­cal home ser­vice mar­ket, the Na­tional Com­mit­tee for Qual­ity As­sur­ance, an­nounced that its new con­sul­tant-aimed med­i­cal home ex­pert-cer­ti­fi­ca­tion pro­gram ap­pears to be an in­stant success. And, next month, it will launch a Pa­tient-Cen­tered Spe­cialty Prac­tice Recog­ni­tion pro­gram that Pa­tri­cia Bar­rett, NCQA vice pres­i­dent of prod­uct devel­op­ment, de­scribes as “rec­og­niz­ing the need for med­i­cal homes to have good neigh­bors.”

A driver be­hind much of this ac­tiv­ity, ac­cord­ing to a Joint Com­mis­sion news re­lease, is “the op­por­tu­nity for in­creased re­im­burse­ment from third-party pay­ers” for those pri­mary-care providers who are op­er­at­ing un­der med­i­cal home stan­dards such as pro­vid­ing co­or­di­nated care with a “whole- per­son ori­en­ta­tion,” of­fer­ing in­creased pa­tient ac­cess and un­der­go­ing con­tin­u­ous qual­ity- and pa­tient- safety im­prove­ment.

Lon Berke­ley, co-project leader for the Joint Com­mis­sion’s Pri­mary Care Med­i­cal Home Ini­tia­tive, said there are more than 100 med­i­cal home demon­stra­tion projects with third-party pay­ers in progress.

“This is a ma­jor di­rec­tion of the health­care sys­tem,” Berke­ley said, adding that the Joint Com­mis­sion re­ceived feed­back from hos­pi­tals it al­ready ac­cred­its that they wanted to take ad­van­tage of new fund­ing op­por­tu­ni­ties but didn’t want to have to deal with two or three dif­fer­ent ac­cred­it­ing bod­ies. So, start­ing this month, the Joint Com­mis­sion is of­fer­ing to con­duct sur­veys for the med­i­cal home cer­ti­fi­ca­tion ei­ther in con­junc­tion with a hospi­tal’s reg­u­lar on­site ac­cred­i­ta­tion sur­vey or sep­a­rately.

Since cer­ti­fy­ing Al­taMed Health Ser­vices, a Los An­ge­les-based sys­tem with 43 sites, as its first med­i­cal home in Au­gust 2011, the Joint Com­mis­sion has gone on to cer­tify 46 other prac­tices as med­i­cal homes. Berke­ley said it ex­pects the num­ber to top 100 by the end of the year.

Be­gin­ning next year, Berke­ley said the Joint Com­mis­sion will be­gin cer­ti­fy­ing “be­hav­ioral-health homes,” for be­hav­ioral­health prac­tices that have a phys­i­cal health com­po­nent. He ex­plained that, of­ten, pa­tients re­ceiv­ing be­hav­ioral-health ser­vices also need treat­ment for di­a­betes, hy­per­ten­sion or in­juries but lack a pri­mary-care provider.

So, he said, they ei­ther get their phys­i­cal needs ad­dressed at the same place they go for be­hav­ioral-health treat­ment or not at all.

Dr. Bruce Ba­gley, Trans­forMED in­terim pres­i­dent and CEO, said the or­ga­ni­za­tion doesn’t en­dorse any ac­cred­it­ing body over an­other, but “any pro­gram that helps ad­dress the proper im­ple­men­ta­tion of the pa­tient-cen­tered med­i­cal home is a good thing.”

Mean­while, since May 2008, the NCQA has rec­og­nized some 5,200 prac­tices as med­i­cal homes. It launched its med­i­cal home con­tent ex­pert cer­ti­fi­ca­tion ser­vice last month to give prac­tices “a way to gauge the qual­i­fi­ca­tions of the grow­ing num­bers of con­sul­tants and other pro­fes­sion­als who of­ten help prac­tices be­come med­i­cal homes,” its news re­lease stated.

Bar­rett re­ports “huge in­ter­est” in the pro­gram, stat­ing in an e-mail that the NCQA has re­ceived more than 1,500 re­quests for the pro­gram hand­book. A Jan­uary train­ing pro­gram in New Or­leans and an Or­lando, Fla., ses­sion sched­uled for March both sold out with about 200 peo­ple reg­is­ter­ing for each.

She said the new Pa­tient-Cen­tered Spe­cialty Prac­tice Recog­ni­tion is de­signed to im­prove qual­ity and also re­duce re­dun­dancy and the neg­a­tive ex­pe­ri­ence pa­tients en­dure with poorly co­or­di­nated care.

“The PCSP pro­gram fo­cuses on proac­tive co­or­di­na­tion and in­for­ma­tion shar­ing among spe­cial­ists and pri­mary-care prac­tices, and re­quires spe­cialty prac­tices to or­ga­nize care across all the prac­tices a pa­tient vis­its—and cen­ter care around the pa­tient as op­posed to the set­ting of care,” Bar­rett said.

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