Small, Solo Family Medicine Practices Lag in Patient-Centered Medical Home Certification


Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON — Federal health policy makers must consider the barriers that solo and small family medicine practices must overcome to become certified as patient-centered medical homes. Without such consideration, progress toward providing a PCMH to all Americans may come to a halt at the doors of these small and solo family medicine practices. 

That is among the conclusions in a one-pager, “Smaller Practices Are Less Likely to Report PCMH Certification” by researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. The one-pager was published in the April 1 issue of American Family Physician.

Researcher Melanie Raffoul, MD, and her Robert Graham Center colleagues reported that, although one-third of family physicians in solo and small practices were considering applying for PCHM certification, only 6.7 percent of solo practices and 18.9 percent of small practices had achieved certification. By comparison, 35.1 percent of large practices were already PCMH-certified. Raffoul drew her data from family physician responses to an American Board of Family Medicine survey question regarding PCMH certification status or plans.

Achieving PCMH certification requires significant investments in new technology, staff training and redesigning process, procedures and office workflow.

“With evolving requirements, the transformation and the certification processes may require costs and time beyond the current capacity of some small practices,” Raffoul and her colleagues write.

Andrew Bazemore, MD, MPH, director of the Robert Graham Center, agreed. “Achieving certification as a patient-centered medical home can require significant outlays for health information technology, staff training and office redesign,” he said. “Decreased self-reported certification among small and solo practices may reflect their challenges in meeting PCMH criteria. 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. Primary care extension programs that are being rolled out by the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid, and continuation of positive payment incentives for HIT and movement toward more coordinated care will likely help practices as well.”

Robert Wergin, MD, AAFP president, pointed to those challenges in recent testimony before the Senate Health, Education, Labor and Pensions Committee. Although family physicians have led the way in implementing electronic health records – a key to PCMH certification – they have faced significant challenges.

“Family physicians were early adopters of health IT because we saw its potential for improving patient care and we still see that potential,” he told the Senate HELP Committee. “…Family physicians are excited about innovative health delivery models, such as patient-centered medical homes, ACOs and telemedicine that rely on health IT. Health IT improves coordination between primary care physicians and subspecialists, hospitals, pharmacies, labs and state health departments. But there is still room for improvement.”

Among his recommendations:

  • Congress and the administration should establish interoperability requirements for EHRs.The Administration should provide regulatory flexibility that enables practices to meet requirements for the meaningful use of EHRs.
  • The Administration should overhaul time-consuming documentation requirements that focus more on billing information than the patient’s clinical information.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.