PCMH Creation Boosts Quality

Physician practices being transformed into patient-centered medical homes (PCMH) might be able to do so while improving quality of care for at least two HEDIS measures — blood pressure control over two years and breast cancer screening over three, according to a study in the Journal of General Internal Medicine.

The study looks at quality and efficiency in practices making the transition into PCMHs. The study group included 18 intervention practices with 43 doctors and the control group consisted of 14 practices with 24 doctors.

The best results are seen in intervention practices that were redesigned (for example, those that use electronic health records more effectively) and were staffed with nurse care managers.

Those practices were also put on a revised payment plan that includes pay-for-performance incentives of up to $2.50 per member per month for improvement in clinical quality.

“In a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over two years, although most indicators did not improve and there were no cost savings compared with control practices,” says the study, “Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial.”

“For the most part,” the study adds, “quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial.”

The blood pressure and breast cancer screening indicators are 2 of 11 HEDIS indicators that are measured.

The nurse care managers kept in contact with high users of emergency departments, “which contributed to the significant reduction in ED visits per episode of care among intervention physicians’ patients,” the study states.

However, “Despite these improvements, we did not observe significant cost savings, and ED costs continued to rise over time, even with the significant reduction in visits observed.”

The reduction in ED visits was modest and outweighed by the increase in costs of visits.