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November 2017

The Impending Death of the Patient-Centered Medical Home

Author Affiliations
  • 1Granite Falls Family Medical Care Center, Granite Falls, North Carolina
JAMA Intern Med. 2017;177(11):1559-1560. doi:10.1001/jamainternmed.2017.4651

From 2000 to 2017, my family medicine practice in Granite Falls, a small town in Western North Carolina, went from a small solo practice to a high-functioning patient-centered medical home (PCMH) with a staff of 14 full-time and part-time employees including an embedded PhD psychologist, PharmD, physical therapist, and dietician. We made this change by leveraging 5 years’ worth of bonuses from the Center for Medicare and Medicaid Services Meaningful Use and Physician Quality Reporting System. In hindsight, these changes put the practice on a nonsustainable path, albeit an altruistic one. Although only about one-quarter of the patients cared for at our practice are Medicare beneficiaries, other insurers and those they insure have benefited immensely. The bonuses enabled us to develop and support the financial structure required to create the PCMH. For the most part, this financial support ended in December 2015. Our financial losses in 2016 are enough to jeopardize the foundation of our PCMH.

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