|New Payment Framework Proposed Under Joint Principles Of PCMH
A payment framework that would reflect the value of
physician care management work that falls outside of a face-to-face
visit has been proposed under The Joint Principles of the
Patient-Centered Medical Home (PCMH) that was endorsed by more than a
dozen specialty healthcare organizations and four primary care
The proposed framework would pay for services associated
with coordination of care, support adoption and use of health
information technology for quality improvement and support provision of
enhanced communication access.
It would also recognize the value of physician work
associated with remote monitoring of clinical data using technology,
allow for separate fee-for-service payments for face-to-face visits,
and recognize case mix differences in the patient population being
treated within the practice.
The PCMH offers the benefits of a personal physician
with a whole-person orientation who accepts overall responsibility for
the care of the patient and leads a team that provides enhanced access
to care, improved coordinated and integrated care, and increased
efforts to ensure safety and quality.
The Joint Principles describe the characteristics of a
practice-based care model for providing comprehensive primary care for
children, youth and adults in a healthcare setting.
The PCMH facilitates partnerships between individual
patients and their personal physicians and –when appropriate
– the patient’s family.
The announcement of the endorsements was made at a
Stakeholders Meeting of the Patient-Centered Primary Care Collaborative
(PCPCC), a group dedicated to promoting the establishment of the Joint
Principles. In addition to physicians and medical students,
PCPCC’s membership consists of national employers and their
associations, healthcare quality advocacy groups, academic centers and
consumer advocacy groups in supporting the PCMH.
The Joint Principles were released in March 2007 by the
American Academy of Family Physicians(AAFP), the American Academy of
Pediatrics (AAP), the American College of Physicians (ACP) and the
American Osteopathic Association (AOA), which together represent some
The pediatricians, family physicians, internists and
osteopathic physicians represented by the four organizations provide
the vast majority of primary care services to children, adolescent and
adult patients in the United States.
The PCPCC received reports from its various
collaborative centers on their work and their goals for future
development. Included was a report on the continuing establishment of
PCMH demonstration projects throughout the country in both private and
The Joint Principles define key characteristics of the PCMH:
- Personal physician – each patient has an
ongoing relationship with a personal physician trained to provide first
contact, continuous and comprehensive care.
- Physician directed medical practice –
the personal physician leads a team of individuals at the practice
level who collectively take responsibility for the ongoing care of
- Whole-person orientation – the personal
physician is responsible for providing for all the patient’s
healthcare needs or taking responsibility for appropriately arranging
care with other qualified professionals. This includes care for all
stages of life; acute care; chronic care; preventive services; and end
of life care.
Care is coordinated and/or integrated across all
elements of the complex healthcare system (e.g., subspecialty care,
hospitals, home health agencies, nursing homes) and the patient’s
community (e.g., family, public and private community-based services).
Care is facilitated by registries, information technology, health
information exchanges and other means to assure that patients get the
indicated care when and where they need and want it in a culturally and
linguistically appropriate manner.
The Joint Principles state that quality and safety are hallmarks of the PCMH.
The statement features eight sub-points highlighting
specific responsibilities, education, decision making, technology,
participation and other necessary elements to improve quality and
The 13 organization newly endorsing the Joint Principles are:
- The American Academy of Chest Physicians
- The American Academy of Hospice and Palliative Medicine
- The American Academy of Neurology
- The American College of Cardiology
- The American College of Osteopathic Family Physicians
- The American College of Osteopathic Internists
- The American Geriatrics Society
- The American Medical Directors Association
- The American Society of Addiction Medicine
- The American Society of Clinical Oncology
- The Society for Adolescent Medicine
- The Society of Critical Care Medicine
- The Society of General Internal Medicine
Address: American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211; (913) 906-6000, www.aafp.org.