Top PCMH Challenge? Coordinating Care with Referral Docs

The Medical Group Management Association says its survey shows that most practices want to become patient-centered medical homes, and finds challenges.
 
Nearly 70% of 341 physician leaders who replied to MGMA’s Patient Centered Medical Home Study: 2011 Report based on 2011 Data said were already in the process of transforming or interested in becoming a PCMH while more than 20% were accredited or recognized as a PCMH by a national organization.

The nationwide survey, conducted in April for Englewood, CO-based MGMA, found the 36% of practices interested in becoming a PCMH were in family medicine, followed by multispecialty practices with primary and specialty care (more than 30%), and pediatrics (more than 10%).

The study found that the top five most common processes practices engaged in as part of the PCMH model were:

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

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

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

For existing PCMHs, 91% 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; 70% 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% of accredited or recognized PCMHs compared to less than 25% for hospital-owned medical practices. Almost 45% of the respondents accredited or recognized as a PCMH were family medicine practices followed by multispecialty practices with primary and specialty care (almost 35%).

The survey also showed that as many as 75% 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% indicated receiving management fees.