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In a 3-year pilot study, small- and medium-sized primary care practices that had created patient-centered medical homes were not successful in reducing costs or curbing hospital and emergency department visits.
The 32 Pennsylvania practices also had a limited effect on quality of care, improving nephropathy monitoring in diabetes patients, but showing no significant improvement on 10 other quality metrics.
The results come from the southeastern region of the Pennsylvania Chronic Care Initiative, a multipayer pilot study that provided technical assistance and financial incentives to internal medicine, family medicine, and pediatric practices, as well as some nurse-managed health centers that were seeking patient-centered medical home (PCMH) recognition from the National Committee on Quality Assurance (NCQA).
The findings were published Feb. 26 in JAMA (JAMA 2014;311:815-25).
Dr. Mark W. Friedberg, of the RAND Corporation in Boston, and his colleagues compared the performance of the 32 pilot practices to that of 29 similar practices in Pennsylvania. Each of the pilot sites achieved NCQA recognition as a PCMH by the third year of the study, with half achieving level 3 status. They earned performance bonuses averaging $92,000 per physician and were successful in making structural changes to their practices, including using patient registries and electronic prescribing.
But the pilot practices fell short in significantly improving quality, cost, and utilization compared with the practices that did not receive technical assistance and bonuses.
One reason that the pilot sites did not see improvements is that the bonus payments, which were tied to achieving NCQA recognition, might have distracted the practices from other activities that could have improved the quality and efficiency of care, Dr. Friedberg and his colleagues wrote. The pilot sites also had no direct incentives to contain costs, and they didn’t get any information on how their patients were utilizing care.
"Possibly as a consequence of these features of pilot design, we found that few pilot practices increased their night and weekend access capabilities, which could, in theory, have produced short-term savings by offering patients an alternative to more expensive sites of care (such as hospital emergency departments)," they added.
On the quality side, the researchers suggested that the pilot practices, which were all volunteers, may have been performing at a high level at the start, creating a "ceiling effect" that made it hard to achieve significant improvements over the 3-year study period.
The study was sponsored by the Commonwealth Fund and Aetna, which had no role in the study’s design or conduct. The investigators reported no relevant conflicts of interest.
On Twitter @maryellenny
The patient-centered medical home may turn out to be like some expensive biomedical technologies that help high-risk patients but not the broader population of patients, according to Dr. Thomas L. Schwenk.
"The PCMH has been promoted for widespread adoption, using a fairly generic and fixed set of structural practice features, even before being fully developed in targeted high-risk populations or before clearly understanding which features or combination of features are most effective with which patients," he wrote in an editorial accompanying Dr. Friedberg’s study.
"It is time to replace enthusiasm and promotion with scientific rigor and prudence and to better understand what the PCMH is and is not. Widespread implementation of the PCMH with limited data may lead to failure," he wrote (JAMA 2014;311:802-3).
Thomas L. Schwenk, M.D., is the dean of the University of Nevada School of Medicine in Reno. He reported no conflicts of interest.
The patient-centered medical home may turn out to be like some expensive biomedical technologies that help high-risk patients but not the broader population of patients, according to Dr. Thomas L. Schwenk.
"The PCMH has been promoted for widespread adoption, using a fairly generic and fixed set of structural practice features, even before being fully developed in targeted high-risk populations or before clearly understanding which features or combination of features are most effective with which patients," he wrote in an editorial accompanying Dr. Friedberg’s study.
"It is time to replace enthusiasm and promotion with scientific rigor and prudence and to better understand what the PCMH is and is not. Widespread implementation of the PCMH with limited data may lead to failure," he wrote (JAMA 2014;311:802-3).
Thomas L. Schwenk, M.D., is the dean of the University of Nevada School of Medicine in Reno. He reported no conflicts of interest.
The patient-centered medical home may turn out to be like some expensive biomedical technologies that help high-risk patients but not the broader population of patients, according to Dr. Thomas L. Schwenk.
"The PCMH has been promoted for widespread adoption, using a fairly generic and fixed set of structural practice features, even before being fully developed in targeted high-risk populations or before clearly understanding which features or combination of features are most effective with which patients," he wrote in an editorial accompanying Dr. Friedberg’s study.
"It is time to replace enthusiasm and promotion with scientific rigor and prudence and to better understand what the PCMH is and is not. Widespread implementation of the PCMH with limited data may lead to failure," he wrote (JAMA 2014;311:802-3).
Thomas L. Schwenk, M.D., is the dean of the University of Nevada School of Medicine in Reno. He reported no conflicts of interest.
In a 3-year pilot study, small- and medium-sized primary care practices that had created patient-centered medical homes were not successful in reducing costs or curbing hospital and emergency department visits.
The 32 Pennsylvania practices also had a limited effect on quality of care, improving nephropathy monitoring in diabetes patients, but showing no significant improvement on 10 other quality metrics.
The results come from the southeastern region of the Pennsylvania Chronic Care Initiative, a multipayer pilot study that provided technical assistance and financial incentives to internal medicine, family medicine, and pediatric practices, as well as some nurse-managed health centers that were seeking patient-centered medical home (PCMH) recognition from the National Committee on Quality Assurance (NCQA).
The findings were published Feb. 26 in JAMA (JAMA 2014;311:815-25).
Dr. Mark W. Friedberg, of the RAND Corporation in Boston, and his colleagues compared the performance of the 32 pilot practices to that of 29 similar practices in Pennsylvania. Each of the pilot sites achieved NCQA recognition as a PCMH by the third year of the study, with half achieving level 3 status. They earned performance bonuses averaging $92,000 per physician and were successful in making structural changes to their practices, including using patient registries and electronic prescribing.
But the pilot practices fell short in significantly improving quality, cost, and utilization compared with the practices that did not receive technical assistance and bonuses.
One reason that the pilot sites did not see improvements is that the bonus payments, which were tied to achieving NCQA recognition, might have distracted the practices from other activities that could have improved the quality and efficiency of care, Dr. Friedberg and his colleagues wrote. The pilot sites also had no direct incentives to contain costs, and they didn’t get any information on how their patients were utilizing care.
"Possibly as a consequence of these features of pilot design, we found that few pilot practices increased their night and weekend access capabilities, which could, in theory, have produced short-term savings by offering patients an alternative to more expensive sites of care (such as hospital emergency departments)," they added.
On the quality side, the researchers suggested that the pilot practices, which were all volunteers, may have been performing at a high level at the start, creating a "ceiling effect" that made it hard to achieve significant improvements over the 3-year study period.
The study was sponsored by the Commonwealth Fund and Aetna, which had no role in the study’s design or conduct. The investigators reported no relevant conflicts of interest.
On Twitter @maryellenny
In a 3-year pilot study, small- and medium-sized primary care practices that had created patient-centered medical homes were not successful in reducing costs or curbing hospital and emergency department visits.
The 32 Pennsylvania practices also had a limited effect on quality of care, improving nephropathy monitoring in diabetes patients, but showing no significant improvement on 10 other quality metrics.
The results come from the southeastern region of the Pennsylvania Chronic Care Initiative, a multipayer pilot study that provided technical assistance and financial incentives to internal medicine, family medicine, and pediatric practices, as well as some nurse-managed health centers that were seeking patient-centered medical home (PCMH) recognition from the National Committee on Quality Assurance (NCQA).
The findings were published Feb. 26 in JAMA (JAMA 2014;311:815-25).
Dr. Mark W. Friedberg, of the RAND Corporation in Boston, and his colleagues compared the performance of the 32 pilot practices to that of 29 similar practices in Pennsylvania. Each of the pilot sites achieved NCQA recognition as a PCMH by the third year of the study, with half achieving level 3 status. They earned performance bonuses averaging $92,000 per physician and were successful in making structural changes to their practices, including using patient registries and electronic prescribing.
But the pilot practices fell short in significantly improving quality, cost, and utilization compared with the practices that did not receive technical assistance and bonuses.
One reason that the pilot sites did not see improvements is that the bonus payments, which were tied to achieving NCQA recognition, might have distracted the practices from other activities that could have improved the quality and efficiency of care, Dr. Friedberg and his colleagues wrote. The pilot sites also had no direct incentives to contain costs, and they didn’t get any information on how their patients were utilizing care.
"Possibly as a consequence of these features of pilot design, we found that few pilot practices increased their night and weekend access capabilities, which could, in theory, have produced short-term savings by offering patients an alternative to more expensive sites of care (such as hospital emergency departments)," they added.
On the quality side, the researchers suggested that the pilot practices, which were all volunteers, may have been performing at a high level at the start, creating a "ceiling effect" that made it hard to achieve significant improvements over the 3-year study period.
The study was sponsored by the Commonwealth Fund and Aetna, which had no role in the study’s design or conduct. The investigators reported no relevant conflicts of interest.
On Twitter @maryellenny
FROM JAMA
Major finding: Primary care practices in the medical home pilot performed significantly better on only 1 of 11 measures.
Data source: Researchers analyzed claims data, survey responses, and performance on NCQA recognition by the 32 primary care practices in the medical home pilot. They compared their performance to that of 29 practices not in the study.
Disclosures: The study was sponsored by the Commonwealth Fund and Aetna. They had no role in the design or conduct of the study. The investigators reported no relevant conflicts of interest.
