The patient centered medical home is a health care setting that facilitates partnerships between patients and their physicians, through the use of both an integrated team-based approach and information technology. It is a model that is often hailed as a savior of primary care medicine.

What is the biggest obstacle to the patient-centered medical home becoming a reality?

Infrastructure costs. Transforming a practice to a medical home requires a fundamental change, including mandatory adoption of electronic medical records. This is a challenge to the 36 percent of physicians who work in solo, or small group practices, and can be particularly difficult in rural areas. When you consider the fiscal circumstances facing doctors today, how are they able to radically convert their practice to meet the strict criteria the medical home demands?

Government support. Senator Max Baucus recently released a white paper, giving guidance to future health care reform. In this plan, he stressed the importance of the medical home. It is imperative for Medicare to realize the potential cost savings that the model can bring, and spend money to properly reimburse the primary care physicians staffing the home, as well as helping practices acquire the necessary information technology.

Specialist support. The American Medical Association’s House of Delegates recently endorsed the medical home. However, the reality is that any increased payments to fund the initiative will be “budget-neutral” in nature, meaning that specialists will face decreased reimbursements. Could this temper their support?

Primary care physician shortage. If you build the medical home, will the primary care physicians come? The number of medical students entering a generalist field is at an all-time low. Even with adequate funding and political backing, there is no guarantee there will be enough doctors to meet our growing primary care needs. Is the situation already too dire for the medical home to save?

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