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PCMHs are not new—the concept dates to the 1960s as a way to care for special needs children. "The biggest challenge to medical homes is payment," notes Michelle Shaljian of the Patient-Centered Primary Care Collaborative, an advocate for PCMHs. Fee-for-service payment, which encourages more costly specialty and acute care, has long prevented primary care practitioners from reorganizing their practices to better serve patients. Traditionally, doctors do not get paid for educating patients or coordinating their care, only for providing services, tests and treatments.
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