Clinicians who use a Patient-Centered Medical Home (PCMH) model to care for their patients make a $105,000 annual investment into that care and get reimbursed for very little of it.

A new study in the Annals of Family Medicine co-authored by researchers at the University of Utah and Integrated Physician Network in Colorado assessed the costs of the PCMH model — which basically employees a team of medical staff to attend to the varied needs of a patient. The model saves upwards of $50 per month per patient (PMPM) as it decreases overall costs for the patients. However, individual clinicians find themselves paying an additional $4 per month per patient that rarely gets reimbursed.

“Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation,” the authors wrote. “Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.”

The study, “The Cost of Sustaining a Patient-Centered Medical Home: Experience from 2 States” — whose authors include Debra Scammon, the Emma Eccles Jones Professor of Marketing at the David Eccles School of Business, and MHA/MBA candidate Andreu J. Reall — examined the costs of 20 care providers in Utah and Colorado.

They found PCMH costs per clinician FTE were $7,691 in Utah and $9,658 in Colorado, and PCMH incremental costs per encounter were $32.71 and $36.68, respectively. Further analysis showed the average estimated costs per member per month for an assumed panel of 2,000 patients were $3.85 in Utah and $4.83 in Colorado.

The authors argue that clinicians should be reimbursed by more than the $4 of raw cost per patient monthly as they are providing more value than the $4 represents.

To read the paper, click here.

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