ENGLEWOOD, CO – MGMA’s Patient Centered Medical Home Study: 2011 Report based on 2011 Data, conducted in April 2011, captured the views of 341 primary care and multispecialty practices nationwide and found that almost 70 percent of respondents were already in the process of transforming or interested in becoming a PCMH while more than 20 percent were accredited or recognized as a PCMH by a national organization. The report is available for free through the MGMA store. MGMA’s study found the majority of practices interested in becoming a PCMH were family medicine (nearly 36 percent), followed closely by multispecialty practices with primary and specialty care (more than 30 percent) and pediatrics (more than 10 percent).

According to the study, the top five most common processes practices engaged in as part of the PCMH model were:

1. Assigning patients to a primary care clinician (more than 80 percent)
2. Addressing patients' mental health issues or concerns and referring them to appropriate agencies (more than 70 percent)
3. Exchanging clinical information electronically with pharmacies (more than 70 percent)
4. Involving patients and family members in shared decision making (more than 70 percent)
5. Maintaining chronic disease registries (more than 45 percent)

“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. “This common sense approach to care coordination and managing chronic disease can contribute to helping us achieve a more efficient, quality-focused health care system.”

The study also indicated the top five challenges cited by PCMHs during their transformation:

1. Establishing care coordination agreements with referral physicians (more than 50 percent)
2. Financing the transformation to PCMH (more than 40 percent)
3. Coordinating care for high-risk patients (almost 40 percent)
4. Modifying or adopting an EHR system to support PCMH related functions (almost 40 percent)
5. Projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH (more than 35 percent)

Existing PCMHs

Ninety-one percent of study respondents said that they want one set of standards for PCMH evaluation. The majority of existing PCMHs were recognized through the National Committee for Quality Assurance (NCQA); 70 percent of these reported earning Level 3 NCQA recognition. The accreditation or recognition process took the majority of respondents, on average, one year to complete.

Physician-owned practices represented less than 55 percent of accredited or recognized PCMHs compared to under 25 percent for hospital-owned medical practices. Almost 45 percent of the respondents accredited or recognized as a PCMH were family medicine practices followed by multispecialty practices with primary and specialty care (almost 35 percent).

Pilot participation

MGMA’s study indicated that PCMH pilots and demonstrations were highly utilized. As many as 75 percent of existing PCMHs reported they were participating in a pilot or demonstration. Ninety percent of pilot participants also were receiving fee-for-service payments from payers as part of the pilots and only 57 percent indicated receiving management fees.

Comparison Tool from MGMA

In addition to the study, MGMA developed a free comparison tool to assess how each of the national programs meets the PCMH Guidelines released by the four primary care professional associations earlier this year.  The programs included in the tool belong to the following national organizations: The Accreditation Association for Ambulatory Health Care, The Joint Commission, The National Committee for Quality Assurance and URAC. The Patient-Centered Medical Home Guidelines: A Tool to Compare National Programs provides a neutral and transparent review of these four organizations’ PCMH programs.