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Health Care Reform and PCMH

The enactment of the Affordable Care Act (ACA) and passage of the Health Care and Education Reconciliation Act mark an important moment for primary care and the medical home. Click here to view a policy brief on Health Care Reform and the PCMH. Below are the major sections of the Health Care Reform bills relevant to the PCMH. These provisions were all supported by our principals and efforts.


From H.R. 3590 Patient Protection and Affordable Care Act

Title II Subtitle I

Sec. 2303 – Payment. See Amendment by Reconciliation Act below

Sec. 2703. State option to provide health homes for enrollees with chronic conditions. Provide States the option of enrolling Medicaid beneficiaries with chronic conditions into a health home. Health homes would be composed of a team of health professionals and would provide a comprehensive set of medical services, including care coordination.

Sec. 2706. Pediatric Accountable Care Organization demonstration project. Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid. The pediatric ACO would be required to meet certain performance guidelines. Pediatric ACOs that met these guidelines and provided services at a lower cost would share in those savings.


Title III

Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within CMS. Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program. Dedicated funding is provided to allow for testing of models that require benefits not currently covered by Medicare. Successful models can be expanded nationally. Section 10306 adds payment reform models to the list of projects for the Center to consider, including medical homes.


Title V

Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home.

Sec. 5501. Expanding access to primary care services and general surgery services. Provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years. Section 10501 removes the budget-neutrality adjustment that would have offset half of the cost of the primary care and general surgery bonuses.


Health Care and Education Reconciliation Act

Sec. 1202. Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014. Provides 100% federal funding for the additional costs to States of meeting this requirement.


Health Care Reform: Resources

The Physicians Foundation released two reports for private practice physicians that examine the provisions of ACA and how these legislative changes will directly affect their practices. The first report, "A Roadmap for Physicians to Health Care Reform," provides physicians with an in-depth perspective on the issues - both societal and economic - that are influencing current reform efforts, as well as insight into the 112th Congress and its possible "reform of the reform." It also focuses on the major legislative changes that hold the most significance to the daily practice of medicine, such as changes in payment systems, quality reporting, shared savings programs workforce and rural initiatives, and select aspects of the changes reshaping the private health insurance market.

The second report, the “Health Care Highway” status report, presents the ongoing changes that are affecting physicians’ private practice of medicine and professional autonomy.

AAFP launched a Health Care Reform Web Page, where members can find answers to some commonly asked questions about how health reform will affect them, their practices and their patients.

While the passage of PPACA has the potential to greatly improve the health care system, the professional lives of family physicians and the health of patients, it requires our continued attention and vigilance. PPACA is not a done deal. It is an evolving set of opportunities. As the provisions of PPACA are rolled out, you can look to CAFP to provide you with answers to your questions and tips to help you take advantage of PPACA's many opportunities.