Medicare’s Patient-Centered Medical Homes Return Mixed Results

Although he has not yet seen an evaluation of a PCMH intervention involving hospitalists, Dr. Friedberg says it would be interesting to see the results of a rigorously studied pilot that involves such an evaluation. A 2012 article in The Hospitalist highlighted one project in Wisconsin and laid out ways in which hospitalists could be involved in PCMH initiatives—among them, being part of hospital admissions decision making and maintaining open lines of communication.⁴ Leaders of that project declined to comment at this time.

“The patient-centered medical home really is an outpatient strategy more than it is an inpatient strategy,” says Robert Centor, MD, MACP, an academic hospitalist at the University of Alabama Huntsville and chair of the Board of Regents of the American College of Physicians, yet he sees a role for hospitalists.

“If we start getting good results with patient-centered medical homes and more people go to the model, a relationship between the PCMH on the outpatient side and a cadre of people who know how to work the inpatient side is going to be critical to success,” Dr. Centor says.

Indeed, Dr. Friedberg says hospitalists’ involvement could be one of the “missing ingredients” that might contribute to the success of any given PCMH intervention, and he’s careful to emphasize there is no such thing as “the medical home.” Rather, there are “many medical homes,” he says.

Dr. Centor says hospitalists could serve as conduits between care inside the hospital and follow-up care, which could reduce length of stay for some patients and smooth the transition from discharge to primary care. A well-versed hospitalist with the PCMH might also assist in reducing repeat tests and procedures.

“I think it comes down to relationships more than anything else,” Dr. Centor says. “The challenge is, given all of the busyness of outpatient practice and inpatient care, how do we best communicate?”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Mathematica Policy Research. Evaluation of the Comprehensive Primary Care Initiative: first annual report. Reference number 40102.R14. Available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf. Accessed March 4, 2015.
2. RTI International. Evaluation of the multi-payer advanced primary care practice (MAPCP) demonstration: first annual report. RTI Project Number 0212790.005.001.001. Available at: http://innovation.cms.gov/Files/reports/MAPCP-EvalRpt1.pdf. Accessed March 4, 2015.
3. Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815-825.
4. Collins T. Patients should prepare for the patient-centered medical home. The Hospitalist. July 3, 2012. Available at: http://www.the-hospitalist.org/article/hospitalists-should-prepare-for-the-patient-centered-medical-home/. Accessed March 4, 2015.