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VOLUME 47 | NUMBER 1.2 | FEBRUARY 2012


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

Keywords: Models;organizational;patient-centered care;organization and administration;primary health care.

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], 42.550.2) of all practices lack sufficient medical home infrastructure. While 72.3 percent (95 percent CI, 64.080.7 percent) of multi-specialty groups would achieve recognition, only 49.8 percent (95 percent CI, 45.254.5 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.

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

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