Many physicians frustrated with their current practice model may have the urge to transition into a Patient Centered Medical Home (PCMH). If that includes you, then there are a few things to consider. The first one is the expense.
What Does it Cost to Set Up a Patient Centered Medical Home?
Fees to consider include:
- Staff time and salaries
- Consultant fees
- Technology fees
- NCQA fees
Reimbursement & Profits
A study issued by the The Medical Group Management Association (MGMA) found that:
PCMHs reported higher general operating costs ($218,800 vs $187,345 per full-time-equivalent [FTE] physician) and higher total support staff cost ($232,346 vs $193,389).
PCMHs needed substantially more staff: a median of 29 FTE support staff per 10,000 patients, compared with 18.5 FTE support staff for those not in a PCMH, Todd Evenson, Vice President of Consulting Services and Data Solutions at MGMA, wrote in an email (T. Evenson, personal communication, 2013).
“PCMH is associated with better-staffed organizations, which are more likely to go after the recognition, but the PCMH doesn’t require more staff — just to utilize staff in a better way. If you’re properly staffed on day 1, you should not need more people in the office; the process involves reorganizing the work — pushing it from doctor to nurse to office staff to computers.”
Donna McCloskey, Director of PCMH for Skylands Medical Group, comprising 19 primary doctors and 3 extenders, added 2 assistants and 3 patient care coordinators.
Glenda Richardson, a solo practitioner felt her costs were minimal.
“I did the documentation during my lunch hour, and I didn’t have to pay Margalit [her consultant],” she says. Richardson was also assisted by a secretary and a recent medical school graduate she’d hired who had computer expertise. “If you are computer-smart, it’s not that bad,” she says.
The process duration to get designation varies but can take 3 months to one year. Generally, a practice involving participation by six or more doctors, can wait 6 months for designation with data tracking. The average is three-quarters of a year to a full year for the whole process.
For McCloskey’s 8 practice sites, it took about 1 year. “We had a team of 6 people, including the lead physician,” she reports. “We had weekly meetings and took each measure at a time.” McCloskey felt that using The Verden Group was instrumental in their getting Level-3 designation. “Some of the material is ambiguous, and having a professional who knows what NCQA was looking for was very helpful.”
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