title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG). Jacqueline_halladay@med.unc.edu.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Halladay
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mottus
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: Kristin
authors.initials: K
authors.lastname: Reiter
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: Katrina E
authors.initials: KE
authors.lastname: Donahue
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: Wilson M
authors.initials: WM
authors.lastname: Gabbard
authors.affiliation: From the Department of Family Medicine (JRH, KED), Cecil G. Sheps Center for Health Services Research (JRH, KED, KM, CMM), the Department of Health Policy and Management, Gillings School of Global Public Health (KR), University of North Carolina at Chapel Hill, Chapel Hill; the University of North Carolina Physicians Network, Morrisville (WMG); and Village Pediatrics of Chapel Hill (KG).
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gush
mesh_terms: D003365:Costs and Cost Analysis; D006284:Health Plan Implementation / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D006801:Humans; D009657:North Carolina; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D018802:Patient-Centered Care / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000592:standards; D014481:United States
keywords: Cost Control; Medical Home; Patient-centered Care; Practice Management