Medical home standards not met by half of physician practices

Nearly half of physician practices do not meet national standards to quality as a Patient-Centered Medical Home, with smaller, single-specialty groups the least likely to qualify, according to a new study.

Primary care practices were a bit better prepared than specialists, noted the study published online in the journal Health Services Research. Even so, 40% of primary care practices would not quality as a medical home under present criteria.

“Our study findings are particularly worrisome because the medical home model of care is seen as providing higher quality, more cost-efficient care” said John Hollingsworth, MD, MS, the lead author, who conducted the study as a Robert Wood Johnson Foundation clinical scholar at the University of Michigan.

Some of the reforms proposed in the Patient Protection and Affordable Care Act depend on medical practices adopting a Patient-Centered Medical Home model of care that can provide continuing care for patients and coordinate medical services among multiple healthcare professionals. The 2010 reforms built in incentives to increase the number of medical homes through support for electronic health records and higher reimbursement rates for practices that meet the standards for medical homes.

The University of Michigan study looked at data from the National Ambulatory Medical Care Survey to determine practice conformance with medical home standards established by the National Committee on Quality Assurance (NCQA) for practice size, organizational structure, and clinical specialty. Researchers found that 72% of multispecialty groups met the standards. Just under 50% of solo/partnership practices, which provide care for nine out of 10 Americans, qualify as medical homes.

Aggregating small practices into larger groups may help more primary care practices meet the standards, suggested Hollingsworth and his colleagues at the Robert Wood Johnson Foundation, sponsor of the study. In rural communities, such combinations may not be feasible and practices may close, reducing access to healthcare in already underserved areas.

Researchers suggest that expanding federal incentives to include assistance for solo/partnership practices to make the changes necessary to adopt the medical home model may help more smaller practices with the transition.

For those practices considering qualification as a medical home, the American College of Physicians offers assistance via its recently updated Medical Home Builder 2.0. The online management support tool guides practices through 13 modules designed to improve office operations and attain the standards necessary to qualify as a medical home.

Go back to the current issue of eConsult.