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Study: Small Doctors’ Practices Not ‘Home’ Yet

A study released Thursday on the Health Affairs website documents how far small- and medium-sized physicians’ practices have to go to create patient-centered medical homes. Under this model of care,  primary care doctors manage all of a patient’s care and coordinate with the specialists. The Affordable Care Act encourages model homes as having potential to reduce costs, improve  health and undo much of the fragmented and confusing maze many patients face today.

The new study examined data on 1,344  practices with fewer than 20 doctors each to see how many had adopted processes that are crucial to medical homes, including assignment of nurse managers to severely ill patients, adoption of  electronic medical records and receipt of regular feedback from patients. On average, the practices in the study only followed 21.7 percent of these medical home protocols. The smaller the practice, the fewer were adopted, the study found.

The authors write:

“Medical home advocates may view our findings as a glass one-fifth full, or four-fifths empty. The more optimistic will appreciate that these smaller practices, typically situated in fragmented care systems across the United States, have already implemented some components of the patient-centered medical home. Others will focus on the low mean level of adoption of the medical home processes measured here, placed in context of the complete practice transformation required to realize the full vision of the patient-centered medical home. From this perspective, widespread implementation appears daunting.”

One finding that surprised the authors: practices serving lots of minority or poor patients weren’t less likely to be using medical home practices.