CMS ’s Latest Report Is Bad News For Medical Homes

Conclusion RTI should never have promised CMS and its readers it would identify factors associated with “outcomes,” improved or otherwise. The definition of the PCMH offered by leading “home” advocates is flabby enough. Trying to test such a wobbly concept in eight states when each state is allowed to use a different definition is just a wild goose chase. Is there anything at all we can learn from such a poorly designed experiment? I’ll attempt to answer that question in subsequent comments. [1] A bizarre feature of this report is the use of two control groups. RTI, perhaps at CMS’s insistence, set up one control group consisting of non-PCMHs, as you might expect, and a second control group consisting of PCMHs not participating in the MAPCP. Setting up a second control group of PCMHs that only differed from the experimental group of PCMHs because Medicare was not one of the participating insurers makes no sense, especially given how poorly PCMHs are defined. RTI then used the results of the comparison with the PCMH control group in a misleading manner. First, RTI conflated the results of the comparisons with the two control groups in the following summary of its findings on spending: “The state initiatives were associated with a slower rate of growth of total Medicare expenditures in only three of the eight MAPCP Demonstration states (Vermont, New York, and Michigan).” (p. 2-41) Upon inspecting the table that this remark refers to (Table 2-9), the reader learn...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized CMS Source Type: blogs