PCMH—a great care model but hard to achieve profitably….

Patient Centered Medical Home is a care model with the potential to improve patient health and the financial health of the practice. As always, the devil is in the details and we’ve seen practices struggle with both NCQA Recognition and managing ongoing PCMH practice operations.
Some of the typical problems we’ve seen:

• Difficulty coping with increased volume of patient visits—if you put your high need patients into care management programs, they’ll be in the clinic more often. Inpractices with a shortage of provider FTEs, that can strain your ability to see your regular patient panel. Appointments can be hard to schedule to meet patient needs, and your existing patients often complain, “I like that practice, but I can’t get in to see my doctor”.
• Increased cost and FTEs—adding new roles for care management and increasing the load on the quality function and IT for reporting increases costs. Practices that don’t find savings to offset the additional cost can see the bottom line slip away.
• Difficulty getting the EMR to generate the necessary reports. Filing for NCQA recognition requires quality and performance reporting that most EMRs don’t handle well. Ongoing PCMH operations requires up to date lists for population management, care management workflow, and care management documentation. Again, most current EMR systems don’t make that easy.
  • Filing for NCQA Recognition is a big effort and it is hard to free up time for the staff to get it done. NCQA’s online documentation filing system does a good job, but has a steep learning curve. Practices have trouble writing reports, assembling quality plans and data, and managing hundreds of documents,. The schedule for filing keeps slipping out. Because it’s a one-time effort, it’s hard to justify training someone to do it.

  Here are some ideas that have worked for our clients:

  • Benchmark your practice to see where there’s room to improve. We have a database of key indicators from 1000+ primary care practices; rural, urban, FQHC, or for-profit, we have the data. We can help you answer questions like—“how many patients a day should my providers see?” or “what’s the ration of costs per encounter to reimbursement per encounter for successful practices?”.
  • Increase the capacity for provider encounters with modest practice tweaking. You don’t have to undertake a radical practice transformation to increase your capacity to see patients. In every practice, there is inefficiency and wasted time in the provider visit processes. A quick study using Lean tools like value stream mapping and root cause analysis will point out the wasted time. Eliminate that waste, and you’ll find more time to see patients. We also provide best practice process designs and documentation so you aren’t reinventing the wheel.
  • Reduce wasted time to free up staff to do other tasks. Practices have been able to free up one or more nurses to do the care management function. All it takes is modest process redesign.
  • Improve the quality of reports from your EMR and practice management systems. Most EMRs are designed to help you achieve Meaningful Use, and while there are lots of reports, only a few of them actually work for PCMH Recognition filing or operating your PCMH practice efficiently. We’ve developed a suite of EMR queries that meet both needs and can help your IT support staff generate high quality reports quickly.
  • Leave the NCQA reporting to us. Assembling your data for recognition is a huge task, and you’ll only do it once every 3 or 4 years. We can help you turn your existing documents into professional looking, high quality documents. If you’re missing some key documents or data, we’ll help you fill in the blanks with our process and data templates. We can also help you stay on track with a proven project management system.

If you would like to learn more about our Lean PCMH model or discuss our work with other clients, please fill in the contact form below with PCMH in the referral code so we know you read it here.