4 Medical Home Obstacles Facing Small Physician Practices

Nutting says he sees some of the changes needed exemplified in a demonstration project involving the American Academy of Family Physicians that began last year.

The demo includes 1,300 family physicians, including some small practices that tested a bundled payment model, which includes fee-for-service, a per-patient-per-month care coordination fee, and shared savings. In a statement, AAFP President Glen Stream, MD, viewed the initiative as a "game changer" because it aligns public and private payers included in medical home models.

In their review of the AAFP project, Nutting and his colleagues found instances in which "practices made much progress in the transformation to [the] patient-centered medical home." Among other things, physician leadership approaches changed dramatically, he says.

"This most often involved rethinking the mission and strategies of the practice; embracing the need for a meaningful care team approach and adopting a pro-active population-based approach to care," Nutting wrote.

The AFFP demonstration project isn't reflective of what's going on in small practices across the country, according to Nutting.

"In most of our work with more typical small practices, however, we have only rarely observed similar transformations among physician leadership, particularly without sustained external support," Nutting wrote.