Association between patient-centered medical home rating and operating cost at federally funded health centers.
BACKGROUND
Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH).


OBJECTIVE
To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration.


METHODS
Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost.


METHODS
Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit.


RESULTS
Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27,300; 95% CI, $3047-$57,804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32,731; 95% CI, $1571-$73,670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39,809; 95% CI, $1893-$63,169).


CONCLUSIONS
According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.
Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA. rnocon@medicine.bsd.uchicago.edu
Robert S
RS
Nocon
Ravi
R
Sharma
Jonathan M
JM
Birnberg
Quyen
Q
Ngo-Metzger
Sang Mee
SM
Lee
Marshall H
MH
Chin
D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics*; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D005380:Financing, Government; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006270:Health Facility Administrators; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000191:economics* / Q000592:standards*; D010820:Physicians / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D011634:Public Health / Q000331:legislation & jurisprudence; D014481:United States