A Medical Home may be coming to your neighborhood soon—and it’s a welcome first step to help consumers and caregivers coordinate complex medical services for family members suffering from chronic, debilitating diseases. CMS will be hosting a public telephone “Open Door Forum” on October 28 describing Medicare’s new Medical Home Demonstration Program, set up by 2006 Medicare legislation, aimed at recruiting primary care physicians and local health clinics to sign up when the program begins next year.

The Medical Home concept began many years ago informally by the families (mostly mothers) of medically fragile special needs children. When I first heard the term, I thought it meant the family’s residence converted to provide sophisticated medical treatment, like Christopher Reeve’s home ventilator. Instead, I learned it means the office of the physician who has developed a relationship with the patient and family, provides ongoing medical treatment and helps coordinate referrals to specialists, rehabilitation therapy, home care, medications, and calls from the emergency room. Currently, these are typically dedicated pediatricians who have helped families keep their fragile children at home and in school, usually out of the goodness of their hearts, because there is little if any reimbursement for the extra phone calls and paperwork.

Medicare’s Medical Home Demonstration will provide extra pay to the primary care physicians (PCP) and clinics that enroll in the demo. These days, finding a PCP who is taking new patients is hard enough, let alone one willing to take a Medicare patient with complex, long term medical needs. Hopefully, the financial and other incentives will open more PCP doors for a successful demonstration project that can be adopted into the general Medicare program.

I reviewed the background material posted to Medicare’s website to see if my husband’s chronic medical condition—right-sided paralysis and speech problems from a severe stroke (from a ruptured aneurysm at age 36)—would qualify him to participate in the demo. The slides did a good job of summarizing the program, and referred covered diagnoses to Table A.1., based on “Hwang et al. Clinical Classification System.” Table A.1 is a twenty-page list of diagnostic code numbers. I guess that disabilities from stroke might fall under “late effects of cerebrovascular disease,” on the list, with about two dozen exact code numbers (without descriptions). I hope CMS has a way to do outreach and translation to eligible patients and families so the PCP’s office doesn’t spend its first month’s stipend looking up covered and non-covered codes for their patients. You can start your research on Medical Home at CMS’s website.

This entry was posted on Monday, October 20th, 2008 at 9:33 am and is filed under Caregiving, Consumer Health Care, Innovation, Insurance. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.