The PCMH Parade


The AAFP loves to put their winners in the limelight and they did it again recently when they paraded out some docs from Rhode Island. These physicians jumped into a PCMH (patient centered medical home) pilot project “thanks in part to financial and technical support from public and private entities”. Never hurts to use other people’s money, I guess.  Anyway, they hired a care manager and trained existing staff to take on additional care tasks” (which I am sure they loved) and the docs proclaimed that this the model can succeed!

Here is how it happened.

  • Rhode Island had an initiative which “began in 2008 as a pilot project involving just five practice sites and is slated to become a nonprofit with a new name, the Care Transformation Collaborative of Rhode Island, in June. About 300 primary care physicians participate in the initiative, which now includes 73 sites and covers an estimated 320,000 patients. The goal is to reach 500,000 patients in the next three years.” (Hmmm, 300 primary care docs divided by 320,000 patients.   That’s a about a 1000 patients per doc.  More than half of a normal doctor’s panel of patients.)
  • Under the program range the docs were paid from $6.50 to $8.75 per patient based on quality performance. Let’s use an average of $7.50.  That would bring in $96,000 a year.  “Participants in the program are expected to use the monthly payments to cover overhead during the transition and to build a sustainable infrastructure, not as a revenue supplement.”  (That’s right.  That money is just for staff.  I guess you are supposed to do this for free.)
  • Practices submit performance data quarterly, and if they don’t meet performance targets, they don’t get bonuses. (Once again, quality metrics have not been proven to improve care but who cares about evidence? )

So what were the conclusions?

  • Overall, fee-for-service still constitutes more than 90 percent of practice revenue, Hurwitz said. She acknowledged that fee-for-service is unlikely to drop to zero in any care delivery model but said it could be reduced substantially by combining a value-based payment with an infrastructure payment and other incentive payments.

The one thing that I have found researching direct primary care, before I jumped in, is that docs who do hybrid models and dabble with both monthly payments and insurance fee-for-service usually fail miserably.  This whole story has more holes in it than swiss cheese.  All this work for 10% of your practice and you are beholden to unproven metrics and begging for grants?  If you read the rest of the article you will see how hard they are trying to convince themselves this is a good thing.  What a joke.




64210cookie-checkThe PCMH Parade