Small, Independent Primary Care Practices Not Ready for the Patient-Centered Medical Home
Boston, MA – According to a new study from researchers at Brigham and Women’s Hospital (BWH), small and independent primary care practices may find it challenging to qualify for higher payments under the Patient-Centered Medical Home (PCMH), a new initiative designed to revitalize the nation’s primary care system. This could undermine access to primary care for communities that rely on these small practices. Detailed study findings, recently released on-line, will be published in the February issue of the Journal of General Internal Medicine.
To address the crisis in primary care, physician professional societies have proposed increasing payments to practices certified as PCMHs. Qualifying practices must develop capabilities such as electronic health records (EHRs) and specially-trained staff who assist patients in managing chronic disease, like diabetes.
In a new statewide survey of Massachusetts primary care practices, researchers found that the largest practices were more than twice as likely as two-physician practices to have EHRs with advanced features (48% versus 19%) and staff to assist patients with chronic diseases (83% versus 39%). Overall, larger practices were more likely to have eight of the thirteen capabilities commonly included in PCMH proposals.
The study authors also found that practices affiliated with large physician networks, such as Partners, Harvard Vanguard, Fallon, and others, were more likely to have multi-functional EHRs than independent practices (40% versus 18%).
PCMH pilot projects are underway in many states, and Medicare will be announcing sites for its own medical home demonstration in 2009. Though the PCMH model is designed to apply to practices of any size, researchers say the discrepancy in readiness for the PCMH may lead to unintended consequences for some primary care practices.
“In the U.S., most primary care practices are small and independent, with only one or two doctors. These small practices may have to invest the most to be eligible for medical home payments,” said Mark Friedberg, MD, a fellow in the Department of Medicine at BWH and lead study author. “Larger practices and those affiliated with provider networks will have an advantage in qualifying as medical homes. If small practices cannot make the necessary investments, they may be driven out of business, threatening primary care access for the communities they serve.”
The research was funded by the Commonwealth Fund.
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.
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