Higher scores as a patient-centered medical home linked to higher operating costs
The model of care known as a patient-centered medical home (PCMH) provides primary care and care management in a patient-centered environment that incorporates principles of quality improvement and enhanced care access. However, federally funded health centers that score higher on PCMH qualities have higher operating costs, reveals a new study. Patient tracking and quality improvement scores were most associated with these increased costs.
The researchers used a survey of all 1,009 federally funded community health centers to determine total PCMH scores ranging from 0 to 100. Six subscales were also measured: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were determined from data submitted to the Health Resources and Services Administration. The final study sample included 669 centers.
The average PCMH score was 60. Each 10-point higher total PCMH score resulted in a 4.6 percent higher operating cost per patient per month. Patient tracking and quality improvement were two of the six subscales associated with higher costs. A 10-point higher score for patient tracking cost the facility $27,300 more per physician full-time equivalent and $1.06 per patient per month. In the case of quality improvement, these costs were $32,731 and $1.86, respectively. Only one subscale, access/communication, was associated with lower operating cost. Here, a 10-point PCMH score resulted in a $39,809 lower cost per physician full-time equivalent. According to the researchers, payment models for PCMHs should be grounded in evidence-based observations of actual costs incurred by practices. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00084).
See "Association between patient-centered medical home rating and operating cost at Federally-funded health centers," by Robert S. Nocon, M.H.S., Ravi Sharma, Ph.D., Jonathan M. Birnberg, M.D., M.S., and others in the July 4, 2012, Journal of the American Medical Association 308(1), pp. 60-66.