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Should Your Practice Seek Recognition as a

PCMH?

Rodney Hornbake MD, FACPEssex CT

drhornbake@comcast.net 860-918-4556

Financial Disclosures

Consulting contract with Gentiva Health Services (NASDAQ: GTIV)

Board of Directors and stock holdings Capital Senior Living (NYSE: CSU)

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35-Year Career

Group practice in rural North Carolina: 1979-1992

Management of hospitals, health systems and for profit companies 1993-2002

Return to clinical practice: 2002-present Career-long devotion to home-based care

as part of a primary care practice (2013: 3933 patient visits including 202 home visits)

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4

Evolution Over the Past 5 Years

Solo practice EMR implementation Group practice formation (3 physicians) Level 3 PCMH Merger with large primary care group

practice (>250 physicians and mid-level providers) 9/1/12

Accountable Care Organization began 1/1/13

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Patient Centered Medical Home

Reengineered primary care AND A new financial model that supports a value

based payment system

BUT NCQA and other certifying bodies ONLY address the structure, process and results of reengineering.

AND reengineering is costly and must be offset by enhanced payment.

THEREFORE you must assess the likelihood that enhanced payment will materialize.

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Scenarios Favoring PCMH Recognition

Dominant payer(s) demand it Dominant payer(s) provide strong

incentives that more than offset the costs of achieving recognition.

An ACO offers your practice the opportunity to provide HBPC to a carefully selected panel of patients, offers FFS and shared savings, and insists on PCMH recognition.

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Where To Learn More

NCQA http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx

Patient Centered Primary Care Collaborativehttp://www.pcpcc.org/

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