The five Patient-Centered Medical Home Accrediting Organizations

• The Accreditation Association of Ambulatory Health Care (AAAHC)  has provided Medical Home accreditation to 73 organizations across 422 practice sites.  AAAHC does not track or report the exact number of providers  participating in their accredited practices.  The following link is to an article by AAAHC describing their accreditation program:  http://jameslhollymd.com/medical-home/pdfs/AAAHC.pdf. (Note:  For analysis purposes, we are going to make the assumption that each “practice site” has an average of three providers or a total of 1,266.) 
• The Joint Commission has accredited 134 organizations with 1315 sites for both ambulatory care and PC-MH.  This includes approximately 3,000 primary care physicians.  This link is to the practices accredited for ambulatory care and PC-MH by Joint Commission: http://www.jointcommission.org/assets/1/6/PCMH_org__list.pdf.  The article at this link is by The Joint Commission and describes the Commission’s PC-MH program:  http://jameslhollymd.com/medical-home/pdfs/Joint-Commission.pdf. 
• The National Committee for Quality Assurance (NCQA) has recognized 8, 112 practices which includes 40,841 practicing primary care physicians .  NCQA does not track the distinction between organizations and locations, i.e., of the 8,1123 “practices” they do not report how many are unique, distinctive organizations and how many area multi-sited organizations.  For instance, SETMA has six sites but is one organization. NCQA reports SETMA as six practices.   Because NCQA is the largest of the accreditation organizations, below there are details of the growth of their recognition of PC-MH since 2010.  The following link is to a description by NCQA of their PC-MH recognition program:  http://jameslhollymd.com/medical-home/pdfs/NCQA.pdf.
• Planetree is the oldest of the PC-MH accreditation organizations but is probably the least well known.  The following is a link to an article which describes Planetree’s accreditation program:  http://jameslhollymd.com/medical-home/pdfs/Planetree.pdf.  Due to Planetree’s methodology and due to their intense focus on cultural changes in medical practices, their accreditation is intense and costly.  As will be seen later, it is SETMA’s judgment that practices which are committed to transformation will add Planetree to their transformation process.
• URAC, which is not an acronym, does not publicly report its numbers of accreditation.  While URAC’s PC-MH accreditation process is relatively new, that should not keep medical practices from discovering the unique benefits they offer in the PC-MH pilgrimage.  The following link is to an article by URAXC About its accreditation program.  http://jameslhollymd.com/medical-home/pdfs/URAC.pdf

Southeast Texas Medical Associates, LLP (SETMA, www.jameslhollymd.com) holds recognitions and/or accreditations from four of these five organizations and has the intention of working with Planetree within the next 24 months.  The dates of SETMA’s accreditation are:

• AAAHC - August, 2010-August 2017
• NCQA - July, 2010-July 2016
• The Joint Commission - March, 2014-March 2016
• URAC - February 2014-February 2017

Methods

With this foundation, we would like to estimate the penetration of the PC-MH model into the primary care practice of medicine.  The method’s we have chosen is an estimate of the numbers of physicians involved in PC-MHs.  The deficiency of this method is that all agencies do not report their accreditations by numbers of physicians.  Another method would be by numbers of practices involved in PC-MH.  The deficiency is that some accreditation organizations do not distinguish between practice organizations and practice sites.  Below at * we discuss brief the definition and numbers of medical “practices” in the USA.

But the greatest deficiency is that recognition and/or accreditation by any or all of these organizations may not be reflect of real, transformation cultural practice changes which will realize the promise of PC-MH. 

NOTE:  URAC and Planetree have very small numbers of physicians involved in accredited organizations.  These should and will grow as their contribution to the PC-MH pilgrimage is recognized.

Penetration as a Percent of Physicians Working in PC-MHs:  18.33%

With NCQA and The Joint Commission numbers and with the estimation of the numbers of physicians working in AAAHC accredited medical homes, there are 45,107 physicians active in medical homes.   AHRQ states that there are 246,090 primary care physicians in the USA: http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html (taken from the AMA Physician Master file 2010).

There are appropriately 661,400 physicians practicing in the USA.   With 246,090 in primary care and 45,107 working in PC-MH practices, 18.33% of primary care physicians are participating in Patient-Centered Medical Homes.

SETMA’s Recommendation

A brief summary of SETMA’s recommendation based on our experience is included the Executive View published by MGMA in the summer of 2014, which can be read at http://jameslhollymd.com/In-The-News/pdfs/mgma-executive-view-summer-2014.pdf. 

The following is the complete text of the article submitted to MGMA concerning SETMA’s recommendation. 

If a practice is very serious about Medical Home, SETMA’s current perspective would recommend that a practice take the following accreditation steps:

1. Pursue and achieve NCQA Tier 3 recognition for PC-MH and deploy the CAPHS-PC-MH program.  Our caution would be for an organization not to assume that this achievement is the end of the medical home pilgrimage but that it is a good beginning.
2. Once this first step is achieved, SETMA would recommend that all groups choose one of the other accreditation bodies (AAAHC, URAC, Joint Commission) for evaluation of the practice.  This assures that the practice’s safety and quality measures required to achieve continuous quality improvement are in place.
3. Once this second step is achieved, SETMA recommends that practices work with Planetree to achieve a Practice Culture assessment for maximum transformative purposes in patient-centered care.

Through SETMA’s experience over the past five years, we have developed an Accreditation Team made up of healthcare providers including physicians, NPs RNs, and LVNs, administration, and IT.  This team’s expertise developed over time to allow the practice to continue to learn from the accrediting bodies without major disruption to the actual practice of PC-MH.

History of NCQA PC-MH Recognition Numbers

September 30, 2014

8,112 NCQA Recognized PCMHs, with 388 in the state of Texas.

Texas:
Level 1, 2 & 3 (in order)

National
 Level 1, 2 & 3 (in order)

November 30, 2011

September 30, 2011 

February 18, 2010

*Group medical practices are defined as "the practice of medicine by a group of physicians who share their premises and other resources."  There are approximately 230,187 physician practices in the United States.  Among these physician practices, 52.8% consist of only one office-based physician. ] The remaining 47.2% of physician practices are group practices.  Physician group practices with 2-5 physicians make up 37.1% of physician offices in the United States. 6.3% consist of 6-9 physicians and the remaining 3.7% consist of 10 or more physicians. In recent years, many small or solo practitioners have come (or are considering coming) together to form larger same (or multi) specialty groups in order to get a leg up on managed care.   Formal Definition by CMS:  The Centers for Medicare and Medicaid Services (CMS) changed the definition of "group practice" in its 2012 physician fee schedule to mean 25 or more eligible professionals in the same practice.   (Wikipedia)

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine 

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center