The article "10 Steps to a Medical Home" by Anton Kuzel MD, published in the American Association of Family Practice's Family Practice Management provides a primary care perspective on the patient-centered medical home sub-headlined as follows:

"Start with steps that increase practice revenue. Then you’ll be better able to afford the steps that just make practice better and more satisfying."

The article continues as follows:

"Assuming current Medicare payment rates, changing to a distribution where most of the codes are 99214 could yield an additional $30,000 to $75,000 per full-time physician per year (how much depends on where you begin, and how close you get to an ideal distribution of codes). See “Coding From the Bottom Up” in the November/December 2008 issue of FPM for more on coding guidelines,6 and see “What improved coding and increased volume can do for practice revenue,” below, for an illustration of the financial impact. If one’s overall payer mix is more remunerative than Medicare, then the impact would be even greater..."

"It would have to stand up to audit," cautions the author, Dr. Kuzel.

Call us cynical here at DMPC World Headquarters (the Barcalounger in my living room), but:

1. Why just "start with steps that increase practice revenue" ? Why not just "end" with those steps too? In any other business, you invest in costs to add revenues. Here the recommendation is to "invest" in revenues to add costs. Why not use the extra revenue from upcoding to "invest" in your kids' tuition?
2. What kind of dramatic patient-centered care innovations start out with a recommendation to physicians to upcode, but do it carefully enough to avoid an audit?

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