The Cost to Successfully Apply for Level 3 Medical Home Recognition

Abstract

Background: The National Committee for Quality Assurance patient-centered medical home recognition program provides practices an opportunity to implement medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work.

Methods: Practice coaches identified 5 exemplar practices (3 pediatric and 2 family medicine practices) that received level 3 recognition. This analysis focuses on 4 that received recognition in 2011. Clinical, informatics, and administrative staff participated in 2- to 3-hour interviews. We determined the time required to develop, implement, and maintain required activities. We categorized costs as (1) nonpersonnel, (2) developmental, (3) those used to implement activities, (4) those used to maintain activities, (5) those to document the work, and (6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent (pFTE) provider.

Results: Practice size ranged from 2.5 to 10.5 pFTE providers, and payer mixes ranged from 7% to 43% Medicaid. There was variation in the distribution of costs by activity by practice, but the costs to apply were remarkably similar ($11,453-15,977 pFTE provider).

Conclusion: The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low-value activities could benefit practices.

Keywords: Cost Control; Medical Home; Patient-centered Care; Practice Management.

Figure 1

PCMH Cost Categories: Making practice changes and applying to NCQA for PCMH recognition

Figure 1

PCMH Cost Categories: Making practice changes and applying to NCQA for PCMH recognition

Figure 2

Activities that required the greatest time investment* (indicated with a “T” for time) and highest value for improving patient care (indicated by a “V’ for value superscript) ^*All activities required at least one full working data (8 hrs.) of staff time to complete, In many cases, especially regarding preparing policy documents, job descriptions, screens shots, documenting chart data into workbooks, and devising plans managing populations this was much greater than 8 hours.

Figure 2

Activities that required the greatest time investment* (indicated with a “T” for time) and highest value for improving patient care (indicated by a “V’ for value superscript) ^*All activities required at least one full working data (8 hrs.) of staff time to complete, In many cases, especially regarding preparing policy documents, job descriptions, screens shots, documenting chart data into workbooks, and devising plans managing populations this was much greater than 8 hours.