It's time to transform your practice into a Medical Home

E-mail address: president@acofp.org.

when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

• Practices advocate for their patients to support the attain- ment of optimal, patient-centered outcomes that are de- fined by a care-planning process driven by a compassion- ate, robust partnership between physicians, patients, and the patient’s family.
• Evidence-based medicine and clinical decision–support tools guide decision making.
• Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
• y Patients actively participate in decision-making, and feedback is sought to ensure patients’ expectations are being met.
• y Information technology is used appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
• y Practices go through a voluntary recognition process by an appropriate nongovernmental entity to demonstrate that they have the capabilities to provide patient-centered services consistent with the medical home model.
• y Patients and families participate in quality improvement activities at the practice level.
• Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physi- cians, and practice staff.
• Payment appropriately reflects the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following frame- work:
• y It should reflect the value of physician and nonphysician staff patient-centered care management work that falls outside of the face-to-face visit.
• y It should pay for services associated with coordination of care both within a given practice and between consult- ants, ancillary providers, and community resources.
• y It should support adoption and use of health information technology for quality improvement.
  
• y It should support provision of enhanced communication access such as secure e-mail and telephone consultation.
• y It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
• y It should allow for separate fee-for-service payments for face-to-face visits. (Payments for care management ser- vices that fall outside of the face-to-face visit, as de- scribed before, should not result in a reduction in the payments for face-to-face visits).
• y It should recognize case mix differences in the patient population being treated within the practice.
• y It should allow physicians to share in savings from re- duced hospitalizations associated with physician-guided care management in the office setting.
• y It should allow for additional payments for achieving measurable and continuous quality improvements.

Medical Home demonstration projects across the country have yielded high-quality care, significantly decreased cost of care, and enhanced reimbursement for physicians.

Recognition as a medical home has been developed by the National Committee for Quality Assurance (NCQA) in the form of 10 standards in three levels of recognition. This process serves to document the quality of coordinated care delivered by physicians. Although the requirements of levels of Medical Home recognition may vary by payor, higher reimbursement will be afforded higher levels of recognition. I encourage you to look at the NCQA website (http:// www.ncqa.org) to obtain comprehensive information about the recognition process.

ACOFP President