Physicians collect bonuses for medical home participation

Patient-centered medical home programs run by commercial insurers have saved these companies money, and physicians are benefiting financially.

Primary care physicians earned $23 million on top of usual fee-for-service payments from CareFirst BlueCross BlueShield, based in Owings Mills, Md., in 2011, the first year of their program, according to a statement the company issued June 7. The insurer saved $40 million. A statement released April 2 by Independence Blue Cross in Philadelphia stated that $37 million was paid out to physicians by their Quality Incentive Payment System program for work in 2011. The total saved by the insurer was not released.

The patient-centered medical home is one of several innovative payment models being tested by government and private payers looking for ways to reduce ever-growing medical expenditures. Patient-centered medical homes run by member companies cover about 4 million patients in 39 states, Washington and Puerto Rico, according to the national BlueCross BlueShield Assn.

MedChi, the Maryland State Medical Society, supports the CareFirst program. The Pennsylvania Medical Society does not officially endorse the one at Independence Blue Cross, but generally supports initiatives that increase physician pay when quality is improved.

“I have not heard a lot of complaining,” said Gene Ransom, MedChi’s CEO. “Physicians have generally said the program has been positive for them.”

In the CareFirst program, about 3,600 primary care physicians formed panels of five to 15 clinicians to care for 1 million patients. Panels included physicians from solo practices as well as those in large groups. The insurer provided practices with online health records and care planning tools, data for practices to identify improvement opportunities and care coordinators to assist with the sickest patients.

Just for participating, physicians received a 12% bump in usual fees paid for services rendered. Devising a care plan for a patient with multiple chronic conditions earned a physician $200. Maintaining and revising a care plan as needed brought in an additional $100.

Nearly 60% of participating physicians earned outcome incentive payments for lowering the total cost of care for their patient population. This means that as of July 1, fees received for services will be increased an average of 20% on top of the bonus for participating in the program. The additional payments will last for at least one year and be extended beyond that if the practice continues to meet quality benchmarks and reduce health care costs.

“This becomes very, very meaningful additional income to these primary care physicians, and each year you have to earn it,” said Chet Burrell, CareFirst’s president and CEO.

An additional 3,000 physicians took part in the Independence program. The insurer provides more money to primary care practices that meet some or all of the National Committee for Quality Assurance’s core requirements to become a nationally recognized patient-centered medical home. The insurer also provided access to various tools to better coordinate care.

Researchers are delving through the data to determine where money was saved. The reductions are most likely to be in cutting duplication of services, emergency department use and hospitalizations.

Participation on the part of physicians and patients in both programs is voluntary.