Physician Practices and Readiness for Medical Home Reforms: Policy, Pitfalls, and Possibilities

Authors

  • John M. Hollingsworth,

    1. University of Michigan, Department of Urology, Dow Division of Health Services Research
    2. University of Michigan, Center for Healthcare Outcomes & Policy
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  • Sanjay Saint,

    1. VA Ann Arbor Health Services Research & Development Center of Excellence
    2. VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program
    3. University of Michigan, Department of Internal Medicine, Division of General Medicine
    4. University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program
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  • Joseph W. Sakshaug,

    1. University of Michigan, Institute for Social Research
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  • Rodney A. Hayward,

    1. VA Ann Arbor Health Services Research & Development Center of Excellence
    2. University of Michigan, Department of Internal Medicine, Division of General Medicine
    3. University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program
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  • Lingling Zhang,

    1. Harvard Business School
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  • David C. Miller

    Corresponding author
    1. University of Michigan, Center for Healthcare Outcomes & Policy
    • University of Michigan, Department of Urology, Dow Division of Health Services Research
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Address correspondence to David C. Miller, M.D., M.P.H., Assistant Professor, North Campus Research Complex, 2800 Plymouth Road, Building 520, 3rd Floor, Room #3172, Ann Arbor, MI 48109-2800; e-mail: dcmiller@med.umich.edu.

Abstract

Objective.

To determine the proportion of physician practices in the United States that currently meets medical home criteria.

Data Source/Study Setting.

2007 and 2008 National Ambulatory Medical Care Survey.

Study Design.

We mapped survey items to the National Committee on Quality Assurance's (NCQA's) medical home standards. After awarding points for each “passed” element, we calculated a practice's infrastructure score, dividing its cumulative total by the number of available points. We identified practices that would be recognized as a medical home (Level 1 [25–49 percent], Level 2 [50–74 percent], or Level 3 [infrastructure score ≥75 percent]) and examined characteristics associated with NCQA recognition.

Results.

Forty-six percent (95 percent confidence interval [CI], 42.5–50.2) of all practices lack sufficient medical home infrastructure. While 72.3 percent (95 percent CI, 64.0–80.7 percent) of multi-specialty groups would achieve recognition, only 49.8 percent (95 percent CI, 45.2–54.5 percent) of solo/partnership practices meet NCQA standards. Although better prepared than specialists, 40 percent of primary care practices would not qualify as a medical home under present criteria.

Conclusion.

Almost half of all practices fail to meet NCQA standards for medical home recognition.

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