Meh... Key is to focus on the compensation portion. Basically, PCP's are asking for reimbursement for their cost centers/overhead which are eaten as the cost of doing business. The argument is that PCP's have a higher overhead cost because they do so much more care coordination. It would be huge if we can convert our cost centers to revenue centers.
If you asked a lawyer/engineer/business consultant to do stuff for you, the time they spend doing it falls under "billable hours". They charge for their research time, phone calls, email, etc. If they write a letter or xerox documents, you get billed for it. Because doctors go through insurance and government to get paid, we have regulations that limit our ability to shift the cost of this kind of work onto the patient/payers.
PCMH is trying to make it that way so that we get paid for the time we spend on the phone & email (like discussing labs over the phone i.e. free versus in person i.e office visit with copay). Get paid for the time our referral coordinators piss away trying to get tests/referrals approved. Get paid for filling out FMLA, disability, PT/OT forms. Get paid for writing a nice email to the consultant for reason of consultation and relevant clinical history... instead of just "referred for abdominal pain." Get paid for dieticians, nurse educators, exercise physiologists to work in our offices. Get paid for the time on hold to get a consultant to send you their clinic notes, chase labs, op notes, and discharge summaries from 5 different specialists, etc.
Now, this can be done on a fee-for-service basis ($X for every phone call we return) or on a PMPM basis ($X per patient per month flat fee) to pay for the paper-pushing. I think they're negotiating/working this out.
To rephrase, it's a proposal to get paid for things that are *supposed* to be done, but usually don't or aren't done well because we (and our staff) (and specialists) don't get paid to do it. And it's a proposal to get paid for things we do for our patients after we leave the exam room and the work we do after patient-care hours. In residency vocabulary, it's a proposal to get paid for scutwork.
It has nothing to do with multi-specialty clinic or gatekeeper model or one-stop shopping real-estate game.
http://www.aafp.org/online/en/home/membership/initiatives/pcmh/brief.html
HOW ARE PHYSICIANS COMPENSATED UNDER THE PCMH MODEL?
The PCMH appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should:
Reflect the value of physician and non-physician staff work that falls outside of the face-to-face visit associated with patient-centered care management.
Pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
Support adoption and use of health information technology for quality improvement.
Support provision of enhanced communication access such as secure e-mail and telephone consultation.
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. (Payments for care management services that fall outside of the face-to-face visit, as described above, should not result in a reduction in the payments for face-to-face visits.)
Recognize case mix differences in the patient population being treated within the practice.
Allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
Allow for additional payments for achieving measurable and continuous quality improvements.
