Nearly 70 percent of 341 primary care and multispecialty practices nationwide surveyed by the Medical Group Management Association are already transforming their practices or are interested in becoming a patient-centered medical home.
"Patient-centered medical homes are helping to better align incentives to reward practices for keeping patients healthy," said William F. Jessee, MD, FACMPE, MGMA president and CEO in a press release announcing the results of the survey. "This common sense approach to care coordination and managing chronic disease can contribute to helping us achieve a more efficient, quality-focused healthcare system."
[See also: Meaningful use incentives included in new PCMH standards; Physician groups release PCMH accreditation guidelines]
The study "The Patient Centered Medical Home - 2011 Status and Needs Study" showed that the primary reasons practices are looking to the PCMH model is to improve the health of patients and to provide more patient-focused care.
"Both physician-owned medical practices and hospital- and IDS-owned medical practices showed high interest in this model of care," noted the report. "This would indicate that there may be significant growth of the PCMH model across the spectrum of care in the near future."
The study noted that the transformation to a PCMH can be difficult in terms of both reorganizing how care is delivered, as well as additional costs incurred by the practices during the transformation.
Other challenges cited by survey respondents included establishing care coordination agreement with referral physicians (cited by more than 50 percent); financing the transformation to PCMH (more than 40 percent); coordinating care for high-risk patients (almost 40 percent); modifying or adopting an EHR system to support PCMH related functions (almost 40 percent); and projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH (more than 35 percent).
"Despite the use of care coordinators more often in existing PCMHs than in transforming practices, established PCMHs reported higher challenges in coordinating the care of their high-risk patients," the report stated. "Perhaps this is because care coordination is a challenging and expensive task that is not fully recognized as such until a practice actually attempts to do it properly. Transformation leaders need to address care coordination, a key principle in the PCMH model."
The most common processes engaged in by practices as part of the PCMH model were: assigning patients to a primary care clinician (more than 80 percent); addressing patients' mental health issues or concerns and referring them to appropriate agencies (more than 70 percent); exchanging clinical information electronically with pharmacies (more than 70 percent); involving patients and family members in shared decision making (more than 70 percent); maintaining chronic disease registries (more than 45 percent).
Of overriding concern among respondents are the competing standards and accreditation programs for PCMHs. Ninety-one percent of survey respondents said they want one set of standards for PCMH evaluation. Most of the practices already accredited were through the National Committee for Quality Assurance (NCQA); 70 percent of these reported earning Level 3 NCQA recognition with 70 percent of those practices having achieved Level 3 recognition. Accreditation and recognition processes took, on average, one year to complete.