Family Medicine Research

Solo, Small Practices Need Help Achieving PCMH Certification

April 13, 2015 02:08 pm Sheri Porter

Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care recently reported that solo and small family medicine practices were less likely than their larger counterparts to achieve patient-centered medical home (PCMH) certification.

[Illustration of a person stopped by a barrier]

The findings were outlined in a policy one-pager published in the April 1 issue of American Family Physician.

Researchers gathered data from family physician responses to a 2013 American Board of Family Medicine (ABFM) survey question about current PCMH certification status or future certification plans.

Specifically, researchers reported that of practices that were PCMH-certified,

  • 6.7 percent were solo,
  • 18.9 percent were small (two to five physicians) and
  • 35.1 percent were large (more than 20 physicians).

Nearly 30 percent of medium-size practices (6 to 20 physicians) had earned PCMH certification.

Furthermore, only about one-third of physicians in solo and small practices that were not PCMH-certified said their practices were considering applying for certification.

Story Highlights
  • New research from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care finds that fewer solo and small family medicine practices seek or achieve patient-centered medical home certification than do medium and large practices.
  • Authors of a policy one-pager note that the transformation and certification processes may require time and funding that is beyond the capacity of some small practices.
  • Researchers noted that policymakers would do well to focus resources on small and solo practices if they want to transform the primary care delivery platform universally.

"With evolving requirements, the transformation and the certification processes may require costs and time beyond the current capacity of some small practices," wrote the authors.

"When setting PCMH certification benchmarks, stakeholders should consider the needs of small practices, which may require additional financial incentives, resources and staff training to facilitate the PCMH transformation," they concluded.

Transformation Brings Both Challenges and Rewards

In a related press release,( Graham Center Director Andrew Bazemore, M.D. M.P.H., acknowledged the significant financial resources necessary to drive both PCMH implementation and certification. Health information technology, staff training and sometimes even a redesign of existing office space all take time and money.

"Decreased self-reported certification among small and solo practices may reflect their challenges in meeting PCMH criteria," said Bazemore.

"It also reminds us of the importance of policymaker focus on these small businesses if we are to transform the primary care delivery platform universally," he added.

In an interview with AAFP News, co-author Melanie Raffoul, M.D., of Washington, D.C., said she experienced the rigors of PCMH transformation during her residency at Wright State University in Dayton, Ohio. "We were transforming to a PCMH practice. It can be very difficult, especially when you have a high patient load. Anything new in that environment -- especially in the beginning -- takes more time and is an irritant," she said.

The key is to push through the difficulties until the new processes become routine, she added.

Raffoul sees promise in the model. "The idea of a busy practice being run as an efficient patient-centered medical home is very appealing," she said.

More Resources Needed to Move Forward

Breaking down barriers that hinder delivery of top-notch patient care was the focus of recent testimony by AAFP President Robert Wergin, M.D., of Milford, Neb., before members of the Senate Health, Education, Labor and Pensions Committee.

For example, when asked about the cost to purchase an EHR system -- an essential part of the PCMH transformation process -- Wergin estimated it at $70,000 to $80,000 per provider, noting that practices also have to buy software upgrades to meet meaningful use standards. Government incentives amounted only to about $44,000.

During Wergin's testimony, senators acknowledged that such expenditures, coupled with increasing regulatory burdens imposed by federal programs designed to boost adoption of health IT, have the potential to derail physicians' efforts to deliver on the promise of enhanced care at lower cost. In fact, Sen. Lamar Alexander, R-Tenn., who chairs the committee, asked Wergin and others who testified to work with policymakers to offer specific, actionable recommendations for how to fix the problem.

As to the future of the certified PCMH practice, Bazemore noted in the press release that CMS and the Agency for Healthcare Research and Quality were launching primary care extension programs to help physicians work through challenges.

"Continuation of positive payment incentives for HIT (health IT) and movement toward more coordinated care will likely help practices, as well," he said.

Related AAFP News Coverage
Public, Private Help Smooth Transition to Medical Home
Rhode Island Pilot Project Now Serves 320,000 Patients and Counting


Is the PCMH Model 'Hot' in Your State?
Free Mapping Tool Tracks Patient-Centered Medical Home Activity


Study Demonstrates Value of Practice Supports During PCMH Transition Process

More From AAFP
The Patient-Centered Medical Home (PCMH)

PCMH Incentive, Recognition and Accreditation Programs

Additional Resource
National Center for Medical Home Implementation(

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