New Workforce, Practice, and Payment Reforms Essential for Improving Access to Pediatric Subspecialty Care Within the Medical Home

Application of the Medical Neighborhood to Children with Severe Obesity

“…16 Expansion of the chronic care model to include the broader medical neighborhood applies coordinated care principles, where predetermined responsibilities are shared among the specialty practice, the patient/family, and the PCMH. 17…”

“…16 Expansion of the chronic care model to include the broader medical neighborhood applies coordinated care principles, where predetermined responsibilities are shared among the specialty practice, the patient/family, and the PCMH. 17 Care coordination within the medical neighborhood includes the core elements of access to primary and tertiary care, communication between families, PCPs and specialists, coordination of providers with defined roles sharing the care of the patient and patient/family inclusion in care planning, and delivery. 12 Elements of care coordination, which could reduce fragmentation for children with severe obesity include (1) assisting child/family with communicating clinical issues, (2) PCP considering consultant recommendations and implementing them when appropriate, (3) facilitating communication among all healthcare-and community-based treatment team members, (4) supporting self-management, (5) supporting and revising care plans (longitudinal plans toward transition from specialty back to primary care and pediatric to adult care), and (6) ensuring successful linkages with community-based resources.…”

Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes

“…But as screening procedures and protocols are encouraged, time and reimbursements remain significant limiting factors. 102,103 Thus, it is imperative that the professionals in the medical home have ready access to tools to provide efficient screening, surveillance, referral, and ongoing collaboration in support of infants/toddlers and EI services. 104 In 2006, the AAP published a policy statement, "Identifying infants and Once the practitioner has identified an eligible infant/toddler in need of services, the family benefits from open and effective lines of collaboration between the medical home and the Part C program.…”

Looming Financial Issues for Medical Homes in Healthcare Reform

“…2 The availability of pediatric subspecialty care and linkage to payments has been well outlined by the Expert Work Group on Pediatric Subspecialty Capacity. 20 In July, the Centers for Medicare and Medicaid Services (CMS) proposed a series of revisions to the Medicare Physician Fee Schedule for calendar year 2010 that, among other things, will eliminate consultation codes (typically paid to specialists at higher rates) and redistribute the resulting savings to existing E&M codes. 21 Opportunities for integrating systems of care must be created in order to share accountability for resource utilization and outcomes across populations.…”

“…Although attention is being focused on primary care payment reform, we must not lose sight of the fact that policy makers must recognize the value provided by subspecialists, including those that are not procedure based. The Medicare Commission made reference to those “which rely heavily on cognitive activities.”2 The availability of pediatric subspecialty care and linkage to payments has been well outlined by the Expert Work Group on Pediatric Subspecialty Capacity 20. In July, the Centers for Medicare and Medicaid Services (CMS) proposed a series of revisions to the Medicare Physician Fee Schedule for calendar year 2010 that, among other things, will eliminate consultation codes (typically paid to specialists at higher rates) and redistribute the resulting savings to existing E&M codes 21.…”