Ancillary services grow as reimbursement increases
Ancillary businesses emerging as reimbursement opportunities grow
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.