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Emerging Healthcare Organizations in an Era of Reform Series
Part 3 - Medical Home Model
This is the third in a series of articles regarding new models and arrangements for emerging healthcare organizations (EHOs) in light of the continuing efforts towards healthcare reform. Past issues discussed Co-management arrangements and Accountable Care Organizations (ACOs). The October 2010 issues of Health Capital Topics will address bundling payments for an episode of care.
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 Emerging Healthcare Organizations: Medical Home Models
Rapidly emerging interest in the Patient Centered Medical Home (PCMH) model is one byproduct of healthcare reform�s attempt to revitalize coordinated care and primary care. Medical home models are a means to reorganize providers to deliver the core functions of primary healthcare following five basic principles: (1) patient centered care; (2) comprehensive team-based care; (3) coordinated care; (4) superb access to care; and, (5) a system-based approach to quality and safety.
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CMS Regulations for Stark Rural & Whole Hospital Exceptions
The Patient Protection and Accountable Care Act (PPACA), enacted on March 23, 2010, amended the rural and whole hospital exceptions to Stark Law, effectively prohibiting any new hospitals from falling within either exception. CMS clarified provisions centered on the PPACA legislation in the Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates, published on August 3, 2010. The proposed rule also limits the capacity and narrows the regulations of each of the exceptions.
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CMS Changes Reimbursement Method for End Stage Renal Disease
CMS replaced the current composite payment system for End Stage Renal Disease (ESRD) patients with a single bundled case mix-adjusted payment as required by Section 153(b) of the Medicare Improvements for Patients and Providers Act (MIPPA) on August 12, 2010. The new regulations will go into effect over a four year transition period for any procedure done after January 1, 2011.
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U.S. Decreasing Healthcare Utilization
Prior to the advent of the recession in July 2007, there had been an annual increase in U.S. utilization of medical services. However, between 2007 and 2009, 26.5 percent of U.S. patients reduced their usage of routine medical care. The total effects of the recession were buffered through the use of government subsidies, which lowered the cost of COBRA insurance by 65 percent, allowing a large proportion of U.S. patients to still utilize the healthcare system. Now, as healthcare reform attempts to lower the cost of care and increase accessibility and utilization, U.S. patients are continuing to cut back on utilization.
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