ARTICLE IN BRIEF
Georgetown University has launched a pilot medical home project around multiple sclerosis care.
The medical home model is not exactly new to neurology. For years, neurologists say, they have had to manage comorbidities of patients with chronic conditions such as epilepsy and multiple sclerosis, coordinating preventive services and acute and end-of-life care — and communicating all aspects of patient regimens between hospitals and nursing homes or other specialists and primary care physicians.
But when Neurology Today reached out to determine how many neurologists had embraced the medical care model — in which each player on the treatment team would be paid separately, but the primary care physicians would receive reimbursement so they'd have more time to invest in face-to-face visits, telephone and e-mail consultations with patients, and discussions with others who are involved in a patient's care — few identified their practices as medical homes.
One neurology practice hopes to change that. Carmelo Tornatore, MD, chair of the department of neurology at Georgetown University Medical Center, has secured private funding to launch the first multiple sclerosis-focused patient-centered medical home within Georgetown's Multiple Sclerosis Center, which he directs.
The medical home is being planned as a clinical trial: 500 of the center's 3,000 MS patients will be recruited into the three-year study. They will be followed for a year under the standard care model, before being transitioned into the patient-centered specialty practice model.
“We are going to compare patient-reported as well as physician-reported outcomes from before the transition and after. Will we have fewer hospitalizations and fewer emergency department visits? Will we see better quality of life measures? We suspect that we will,” Dr. Tornatore said. “The whole idea is to take a more proactive approach to caring for patients, rather than being reactive.”
The practice will identify patients with higher needs — those with more active disease, who may have more hospitalizations or more emergency department visits — and do a “gap analysis.”
“Maybe they need more social services. Maybe their disease-modifying agent is incorrect, maybe they need physical therapy. Maybe they are underinsured and we need to look at their insurance,” said Dr. Tornatore. “We will focus on identifying those at-risk patients and take a multidisciplinary approach to intervention.”
Days will be set aside for patient education — time that should become available because clinicians can do much more with telemedicine and other methods rather than being subjected to what Dr. Tornatore calls the “tyranny of the office visit.”
“Our schedules shouldn't be jam-packed because we're taking care of things in other ways, so the patients who need to come in truly are acute,” he said.
Dr. Tornatore believes that this concept is the value-based proposition that Medicare and third-party payers are looking for. “Medicare is interested in moving more away from fee-for- service and toward outcomes,” he said.
“This is a way for neurologists to start moving in that direction and to start quantifying the tremendous value of what we bring to patients. They are asking for these alternative payment models [APMs] by 2019 or 2020. Couldn't one of those APMs be a neurology specialty home, where we get paid as a lump sum for this group of patients, and we have quality measures that we have to meet?”
The trial, he added, will also look at the economics of such a plan. “We want to understand the level of reimbursement that is needed to take care of patients with a chronic disease like multiple sclerosis in a patient-centered approach.”
Dr. Tornatore suggests that the patient-centered specialty home could be a model for multiple sclerosis centers and other neurology practices throughout the country. “You could have an epilepsy-centered specialty home, one for Parkinson's, one for Alzheimer's — the concept is the same. For people with chronic neurologic disorders, we are their primary care provider.”