Last week, I wrote about the new “Advanced Primary Care” (APC) model demonstration announced by the Department of Health and Human Services, and how it might interact with the previously announced – but not yet implemented – Medicare Medical Home demonstrations.  In that post I noted that the healthreform.gov fact sheet stated the two demonstrations would move forward together in 2010, and the CMS webpage for the Medicare Medical Home demonstration hadn’t been updated since April.  Well, both of those situations have changed.  The CMS webpage was updated on Monday stating that the Medicare Medical Home Demonstrations will not be moving forward because the House version of health reform legislation would repeal the Medicare demonstration and replace it with two other medical home demonstrations – one independent practitioner-based and the other community-based.  (See bottom of post for text of CMS webpage update.)

Hurry Up and Wait
So while the APC demonstration linking Medicare, Medicaid and private payers for medical home projects is presumably moving forward, we’ll have to wait until health reform legislation gets wrapped up to see if it will have any Medicare specific companions.  Similarly, we’ll have to wait and see how much of the Federal legislation is devoted to delivery system reform via medical homes, accountable care organizations or other initiatives, how much is payment system reform, how much is cost containment, how much is coverage expansion, and overall, how much of it locks in some of the current system’s structure, i.e. in a new public plan option – for which a preferred form seems to changing almost daily.

Stay tuned, and keep your seat belts fastened and tray tables closed, it’s likely going to be a bumpy ride for the next several weeks.

The full update from the CMS webpage is below:

10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of House Bill 3200 contains a provision to repeal this demonstration and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.

At this time, CMS believes it would be impractical to pursue clearance of the Medicare Medical Home Demonstration, which has been under review at the Office of Management and Budget, given the pending legislation that would repeal it and replace it with a similar pilot. CMS is moving forward with an Administration-initiated demonstration announced by Secretary Sebelius on September 16, 2009, whereby Medicare would partner with existing multi-payer medical home pilots to improve the delivery of care. This demonstration, titled the Multi-Payer Advanced Primary Care Practice Demonstration, would be implemented in 2010.