Understanding the Patient-Centered Medical Home


PA Roles in the Medical Home — What Congress Says

On November 7, 2009, the House passed HR 3962, the Affordable Health Care for America Act. The bill defines PAs as primary health care providers and stipulates that PAs may lead the primary care team in the new chronic care management model.  It also includes the following requirement for certification of community-based medical homes – “the organization provides medical home services under the supervision of and in close collaboration with the primary care physician, nurse practitioner, or physician assistant designated by the beneficiary as his or her community-based medical home provider.” See AAPA press statement on HR 3962.

The Senate expects to begin debate soon on merged health care reform bills reported by the Senate Finance and HELP Committees. AAPA has asked that the senators retain language from the Senate Finance bill integrating PAs into new patient care models in primary care and chronic care management, treating PAs in the same manner as physicians and nurse practitioners, recognizing PAs in incentives for chronic care management bonuses, and making PA eligible for primary care provider bonuses.  Read more ...

PA Roles in the Medical Home — What States Say

Many states name PAs as qualified principal primary care providers for patients in medical home practices. Positive language exists in law and in state-level demonstration policies.  For a complete state-by-state summary, click here.

California
The California Assembly Bill 1542 “Patient-Centered Medical Home Act of 2009” defines the medical home as “a team approach to providing health care that fosters a partnership among the patient, the personal provider, and the patient’s family. It defines the “personal provider” as “the patient's first point of contact in the health care system with a primary care provider who identifies the patient's health needs, and, working with a team of health care professionals, provides for and coordinates appropriate care to address the health needs identified." Read more ...

Iowa
The Medical Home System Advisory Council Progress Report #1
Iowa law defines the medical home as “ … a team approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient's family; utilizes the partnership to access all medical and nonmedical health-related services needed by the patient and the patient's family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care ... . "  The law includes physician assistant in its definition of  "primary care provider" and describes the medical home as a “provider-directed medical practice” in which each patient has “an ongoing relationship with a personal provider.” Read more ...

Louisiana
The Patient-Centered Medical Home in Louisiana, 2008 report
Louisiana's Health Care Quality Forum adopted the physician-derived "Joint Principles of the Patient Centered Medical Home." However, the Forum states,  “While much language contained in the attached document focuses on the 'physician,' the committee believes that any design of a patient-centered medical home must be responsive to the locale of the individuals accessing care and the available resources; therefore, it is not required that the patient-centered medical home be physician directed. The definition of the model does not require a particular degree or license; however, it does require that functions and outcomes are delivered in a measurable manner by licensed providers.”  Read more ...

Maine
Guiding Principles for Maine Patient Centered Medical Home
Maine endorses the physician-derived "Joint Principles of the Patient-Centered Medical Home," yet envisions "practice teams that may be broad and varied in their composition," recognizes PAs as "important members of the primary care practice team," uses the term, "personal primary care provider" instead of "personal physician," and prefers the term, "primary care practice" over the term, "physician-directed medical practice." Read more ...

Michigan
Michigan Primary Care Consortium
“The team concept is critical to the transformation of primary care to maximize quality, efficiency and value. Although a physician will often be the primary care team leader, a nurse practitioner or physician assistant may also function in this role." This report by the state’s Primary Care Consortium notes, “Team care involves delegating all care functions that are not essential for the physician to perform to members of the health care team, who work at their highest level of training, licensure and experience. Read more ...

Minnesota
Minnesota's Vision: A Better State of Health
Called a "health care home" in Minnesota, these programs must "emphasize, enhance, and encourage the use of primary care, and include the use of primary care physicians, advanced practice nurses, and physician assistants as personal clinicians" and "provide patients with a consistent, ongoing contact with a personal clinician or team of clinical professionals to ensure continuous and appropriate care for the patient's condition."  The law defines "Personal clinician" as " ... a physician licensed under chapter 147, a physician assistant licensed and practicing under chapter 147A, or an advanced practice nurse licensed and registered to practice under chapter 148." Read more ...

PA Roles in the Patient-Centered Medical Home — What PAs Say