[Update: don't miss this chance to attend a 2014 PCMH Prep course taught by Susanne Madden at the PCC UC. You don't have to be a PCC client to attend.]

Perhaps that's a misleading title, but it is a possible conclusion to draw from a recent survey we did of our clients.

We needed to assess our clients' focus on both PCMH and MU requirements for 2014 and beyond to help plan where to apply our resources.  Are practices burned out on the PCMH concept?  Do pediatricians care about Years 2 and 3 of MU?  What benefits have practices felt from PCMH recognition?

We learned a lot, I'll share some of it with you here.  One note regarding survey bias: I suspect that practices with little or no knowledge of PCMH are less likely to have participated in the survey.  Same with MU, I suppose.  But I suspect that the interest in PCMH is overstated here in general (but the results are telling nonetheless).  The results:

• We had more than 50 respondents to the survey, all pediatric of course.
• 1/3 had applied for PCMH previously.  Some as early as 2011, some as recently as last week.
• 70% of our clients received Level 3, 20% received Level 2, and 10% received Level 1 recognition.
• Without any prompting whatsoever, the PCMH application processwas described this way:
  • time consuming, labor intensive (50%)
  • painful (30%)
  • tedious (25%)
• More than 80% of those who have received recognition plan to apply again.
• More than 80% of the PCMH applicants used PCC's help and PCMH resources, like pcmh.pcc.com. Those who didn't were all early PCMH adopters and PCC didn't have many resources in place yet.
• 70% of the PCMH respondents used The Verden Group's consulting to get through it. Comments include:
  

  • They are the best of the best and couldn't have done it without them.
  • Outstanding, and critical to our success.
  • Excellent- even though I have done this before, having Julie available to proofread my submissions was well worth it! Her predictions were very accurate.

• The financial impact of PCMH recognition varied, but responses included:
  

  • annual per member payments totaling about $32,000
  • Still waiting, West Coast isn't as ready as east coast
  • Will qualify for BCBS higher tiered fee schedule.
  • Increased per capita reimbursements
  • $2500 per quarter
  • We get incentive checks from if we do care plans for chronic patients
  • 20 % increase in BCBS payments
  • Increased reimbursement from BCBS and Medicaid
  • a per member per month payment of about $3 from insco.

• The clinical benefits of PCMH recognition included:
  

  • Better policies and procedures are in place
  • Data tracking, closed the loop with referrals
  • we have a co-located Registered Dietitian and an Asthma Educator, each for a 1/2 day per week through funding available because we are a PCMH.
  • Very few of the procedures put in place have helped with patient care. We mostly now document what we were already doing.
  • Some better follow up of patient testing and patient communications
  • Better tracking and reporting of lab and radiology results.
  • Better patient tracking, better office procedures
  • Protocol standardization and increased rate of well care

• Across all respondents, 70% plan to (re)apply for PCMH recognition in 2014 and beyond.
• Only half of those expecting to (re)apply in 2014, however, are aware of the deadlines for the 2011 requirements (June 30, 2014).

As for Meaningful Use...

• 60% of respondents expect to apply for MU funds in 2014 and beyond. 20% are going for Stage 1, Year 1; 45% are going for Stage 1, Year 2; 35% are going for Stage 2.
• PCMH is more important to our clients by 65/35 margin. Why?
  • Why is MU more important?

  • If I have to pick one, it is MU b/c it carries real money now. But, PCMH practices, whether NCQA recognized or not, bring improved contracts due to our ability to document improved cost-containment to the carriers.
  • Seems more easily obtainable. I have a small office staff and not able to devote time to PCMH.
  • More familiar with MU
  • The financial incentives. Also, we've gotten a lot of help through our REC, which has made the process less intimidating. At this point not sure the benefits of PCMH other than distinguishing ourselves in the community.
  • Do not want money from government, however, feel that meaningful use
    changes are good idea.
  • While being a Patient Centered Medical Home is important it meets the needs of just one population of patients, our special needs and chronic health care need population. Meaningful use covers the standard for the entire patient population.
  • Greater financial benefit

  • Why is PCMH more important?

  • We are not MU eligible.  [we heard this 10x]
  • Being the medical home for our patients is extremely important as care
    for the patient should begin and end with us as we are the primary care
    providers.
  • Following PCMH guidelines will assist in getting all of my providers on the same accord where they will be essentially "forced" to do things unanimously by following established protocols.
  • My practice doesn't meet the MU Medicaid requirement long term reimbursement will trump the short lived MU monies.
  • I think the PCMH is a GOOD CONCEPT
  • MU was more money, but they are not easy to work with.
  • We have heard that our state, California, will actually have its own PCMH-type of qualifications so we are waiting to see the outcome of that.
  • I think it will be more helpful in the long run.
  • MU in the later stages is forcing a lot of effort toward things we don't find useful eg the electronic handouts, and the patient portal for which we are experience about zero patient demand.
  • .$$ are more substantial with our payer grouping
  • PCMH because the kids we care for are underserved, sometimes unfairly prejudged, uneducated, underfunded, under-resourced and in desperate need of constant guidance and assistance throughout the healthcare system for basic preventive needs.
  • Much more money for PCMH in our state. Peds practices can take the year 1 money and run for buying a certified EHR. The additional 8k/year is not worth the total PITA of the MU program.
  • Little financial reward for stage 2/3 MU. Higher reimbursement for PCMH.
  • We have already gotten 3 years of MU and the payments decline as the requirements increase including some that we really don't feel are helpful. NCQA will qualify us for larger payments on a longer horizon.

Interesting, no? Check out the new survey over there on the right - add to this discussion.