Physician practices and readiness for medical home reforms: policy, pitfalls, and possibilities.

OBJECTIVE To determine the proportion of physician practices in the United States that currently meets medical home criteria. DATA SOURCE/STUDY SETTING 2007 and 2008 National Ambulatory Medical Care Survey. STUDY DESIGN We mapped survey items to the National Committee on Quality Assurance's (NCQA's) medical home standards. After awarding points for each "passed" element, we calculated a practice's infrastructure score, dividing its cumulative total by the number of available points. We identified practices that would be recognized as a medical home (Level 1 [25-49 percent], Level 2 [50-74 percent], or Level 3 [infrastructure score ≥75 percent]) and examined characteristics associated with NCQA recognition. RESULTS Forty-six percent (95 percent confidence interval [CI], 42.5-50.2) of all practices lack sufficient medical home infrastructure. While 72.3 percent (95 percent CI, 64.0-80.7 percent) of multi-specialty groups would achieve recognition, only 49.8 percent (95 percent CI, 45.2-54.5 percent) of solo/partnership practices meet NCQA standards. Although better prepared than specialists, 40 percent of primary care practices would not qualify as a medical home under present criteria. CONCLUSION Almost half of all practices fail to meet NCQA standards for medical home recognition.