The questionable usefulness of NCQA certification or recognition, which Friedberg says requires "a major effort and extra time, even the process of submitting the NCQA application, to receive recognition," prompted a NCQA response.
The NCQA said the pilots in the Friedberg study were rated on "outdated" NCQA standards for patient-centered medical homes that have since been revised. The organization said Friedberg's report "contradicts several others that have shown improvements in cost, quality, access, and patient experience." That evidence is why "most states and many private and commercial insurers support PCMHs with financial or technical support."
The NCQA intends to give an additional update on its requirements with new standards in March.
In the Pennsylvania pilot, commercial payers and Medicaid health plans paid the physician practices in the pilot about $92,000 per practice in bonuses, which they could have used to expand or support personnel or technology in an effort to improve care to patients beyond the office visit. They also received traditional fee for service payments.
There was no payment incentive for keeping patients out of the hospital, or for avoiding emergency department visits for medical complaints that could have been handled in an outpatient setting. That may be the next thing to come.
An Anthropologist's View
Ben Crabtree, an anthropologist who has teamed up with physician researchers under a Robert Wood Johnson grant to evaluate pilot models of innovative practices including PCMHs, says physician practices need to be totally redesigned with a care coordinator who is part of the team in order to make the concept work.