Small primary-care pediatric practices may be disadvantaged when it comes to achieving designation as a medical home, according to a study conducted by C.S. Mott Children's Hospital, Ann Arbor, Mich.

Primary-care practices are under financial pressure to become designated as medical homes, which receive extra funding under the healthcare reform law to coordinate patient care and lower overall costs. However, because most primary care for children is conducted in offices that employ five or fewer physicians, those smaller practices may not have the necessary resources to reach the medical home status. As a result, they miss out on the tools and support provided to medical home program participants by the CMS.

“Getting recognized as a medical home is often the first step for practices to participate in programs that are trying to improve primary care for children. These practices can be at a serious disadvantage,” Dr. Joe Zickafoose, a pediatrician at the University of Michigan and the lead author of the study, said in a release.

For the study, published in the March issue of Pediatrics, researchers looked at data collected from the 2007 and 2008 versions of the National Ambulatory Medical Care Survey. The yearly survey involves outpatient visits to non-federally employed, office-based physicians that have been randomly chosen.

Investigators used survey comments from physicians about certain characteristics of their practices, as well as information from the National Committee for Quality Assurance's Patience-Centered Medical Home standards. They found that most pediatrics and family medicine practices met 38% of these standards, but smaller practices scored 10 to 14 points lower (on a 100-point scale) than medium and large practices.

“We hope that our study helps reinforce the importance of providing additional supports to small primary-care practices in efforts to improve healthcare for children,” Zickafoose said.

The study was performed by researchers at the Child Health Evaluation and Research Unit of the University of Michigan and its C.S. Mott Children's Hospital. The research unit was established to analyze the healthcare system, especially as it relates to pediatric care. Since it was founded in 1998, the organization has received more than $40 million in federal, state and foundation grants to research community, state and national child health policies, practices and programs.