Graham Center Policy One-Pager

Smaller Practices Are Less Likely to Report PCMH Certification


Am Fam Physician. 2015 Apr 1;91(7):440.

Despite efforts to achieve broad transformation of primary care practices into patient-centered medical homes (PCMHs), certification rates have lagged in small and solo practices. The challenges these groups face with the transformation and certification processes should be addressed to continue national momentum toward reshaping the nation's primary care platform.

Since 2007, efforts to transform the nation's largest platform of health delivery, primary care practices, into PCMHs have included substantial investment by stakeholders, payers, and practices, and have resulted in multiple PCMH certification processes. Some have noted, however, that small practices are more challenged by benchmarks of PCMH certification, including integrating new technology; reenvisioning the physician's role; and adjusting the practice culture, structure, and cost.1,2

Family physicians recertifying with the American Board of Family Medicine in 2013 were asked if their practice was a PCMH or if they were considering applying for certification.3 Substantially fewer physicians in solo practices (6.7%) and small practices (18.9%) reported PCMH certification relative to those in large practices (35.1%). One-third of physicians in solo or smaller practices reported that their practices were considering applying for certification.3

Transformation of the primary care delivery platform will be incomplete without the participation of small and solo practices. With evolving requirements, the transformation and the certification processes may require costs and time beyond the current capacity of some small practices. 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.4

Figure 1.

Patient-centered medical home (PCMH) certification status of family physicians by practice size.

Information from reference 3.

Figure 1.

Patient-centered medical home (PCMH) certification status of family physicians by practice size.

Information from reference 3.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at

Policy One-Pagers are available from the Graham Center at

Author disclosure: No relevant financial affiliations.


show all references

1. Rittenhouse DR, Casalino LP, Shortell SM, et al. Small and medium-size physician practices use few patient-centered medical home processes [published correction appears in Health Aff (Millwood). 2011;30(11):2219]. Health Aff (Millwood). 2011;30(8):1575–1584....

2. Berenson RA, Hammons T, Gans DN, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27(5):1219–1230.

3. Maintenance of certification demographic survey. Lexington, Ky.: American Board of Family Medicine; 2013.

4. Scholle SH, Asche SE, Morton S, Solberg LI, Tirodkar MA, Jaén CR. Support and strategies for change among small patient-centered medical home practices. Ann Fam Med. 2013;11(supp 1):S6–S13.



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