February 1, 2008

1. NIH Sets FY 2008 Fiscal Policy for Grant Support

2. Coalition Rewards Physicians Treating Patients in ‘Medical Home’

1. NIH Sets FY 2008 Fiscal Policy for Grant Support

Announced Monday, January 28, 2008, the National Institutes of Health (NIH) set its fiscal year (FY) 2008 fiscal policy for grant support based on the recently passed Consolidated Appropriations Act of 2008 (PL 110-161). Because Congress increased NIH’s budgetary support by one percent, to $29.2 billion from $28.9 in FY 2007, the agency cannot alter award support to fully cover its three percent inflation commitment for non-competing research awards. Meanwhile, competing research award grant sizes may increase by one percent in accordance with the legislated increase.

NIH’s policy requires each Institute and Center to “use its own discretion to allocate the [one percent] adjustment among its non-competing research grants.” However, the policy does not apply to Career Development Awards, Small Business Innovation Research and Small Business Technology Transfer Grant Awards, and Ruth L. Kirchstein-National Research Service Award Individual Fellowships and Training Grants. For non-competing grants awarded during the continuing resolution (awarded at approximately 80% of the previously committed level), NIH will revise the amounts to reflect the new policy.

According to NIH, Institutes and Centers may increase their competing grant award support by one percent over FY 2007 allocations. NIH approximates the increase in funding should provide for 9,700 new and competing research project grants. In addition, in FY 2008, NIH plans to retain the same number of new investigators as averaged in the past five years, continue the NIH Director’s Innovator Awards and NIH Pathway to Independence Awards, and utilize the NIH Director’s Bridge Award Program “to help balance the grant cycling variation challenges and support other approaches to sustain established grantees and first-time competing renewals.”

2. Coalition Rewards Physicians Treating Patients in ‘Medical Home’

A coalition of large employers is launching a program to provide bonuses to primary care physicians who implement the “medical home” approach of integrating coordination of care for patients, especially those with chronic conditions. According to the Wall Street Journal, the initiative, which is part of Bridges to Excellence—a non-profit coalition-based organization created to promote quality of care by rewarding health care providers who deliver high-quality care—is an “ambitious effort to shore up US primary care medicine.”

Under the program, a patient’s primary care physician will serve as the core of the medical home through which the patient receives acute, chronic, and preventive care. The medical home’s responsibilities will include following up on referrals to other physicians; tracking and flagging test results; and adhering to a set of evidence-based medical guidelines to monitor and treat a variety of chronic illnesses.

Primary care physicians who implement the medical home will receive $125 per year for each patient covered by participating employers with up to a maximum of $100,000 in total rewards annually through the program. Bridges to Excellence estimates that improving health care quality through the patient-centered medical home will save double what physicians will receive in bonuses—approximately $250 to $300 per patient in the first year.

Physicians will receive Bridges to Excellence Medical Home distinction when they demonstrate effective use of the medical home to provide patients with access to high-quality health care while practicing evidence-based medicine; implement appropriate health information technology; and demonstrate the use of best practices. Physicians will be accountable for the quality of the care they provide. Physicians can also achieve medical home recognition if they successfully implement two other Bridges to Excellence programs, such as the diabetes or cardiac care link programs.

While this initiative is being conducted as part of Bridges to Excellence, the concept of the patient-centered medical home was developed by the American Academy of Pediatrics. Since development, the concept of the medical home has been adopted by several organizations, including the American College of Physicians (ACP). According to ACP President David C. Dale, MD, “practices electing to become a patient-centered medical home commit to providing care that recognizes the true value of partnership between patients and their personal physicians—who in turn accept the accountability and responsibility of improving quality of care.”

For more information about Bridges to Excellence and its medical home initiative, please visit www.bridgestoexcellence.org.

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Associate Nicole V. Baptista (nbaptista@im.org), or AAIM Policy Assistant Allison L. Haupt (ahaupt@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.