Journey to PCMH Recognition
Elaine M. Skoch, RN, MN, NEA-BC
Director, Systems Transformation
Insert Title Here
1
Transformation to PCMH
• Revolves around the patient…is “person
centered”
• Creates healthcare “partnerships”
• Requires a “systems” perspective
• Elements are inter-related and interdependent
Transformation to a PCMH (cont.)
• Calls for leadership, communication &
teamwork
• with a common language & understanding of
the goals at hand
• Necessitates flexibility
Transformation to a PCMH (cont.)
• Focuses on:
• Access and barriers to care
• Care management
• Continuity of care
• Aided and supported by technology
• Team based; relationship centered
Transformation…
• Requires a team effort
• Cannot be achieved merely through new
technology
• Takes time
• Can take unexpected turns
Creating a Patient Centered
Medical Home…
Requires attention to relationships:
• Between the practice and the patient
• Among members of the practice
• Between the practice & the community
Practice Redesign…
Requires review of:
• Work processes and team structure
• Organizational structure
• Utilizing technology to support the delivery of
care
Practice Transformation
is a
Performance Improvement
Process
First Steps in NCQA
Recognition
 Define the project team to work on the process
◦
◦
◦
◦
Physician champion
Computer skills
Administrative information (policies & procedures)
Nursing
 Purchase the Interactive Survey Tool (ISS Tool)
($80)
http://www.ncqa.org/tabid/629/Default.aspx#pcmh
 Assign responsibilities and dates for task
completion in order to meet the target date for
submission
To Access NCQA Documents
• http://www.ncqa.org NCQA Home Page
• http://www.ncqa.org/tabid/62/Default.aspx
Publications and Products Page
• http://www.ncqa.org/tabid/629/Default.aspx
PPC-PCMH Publications Page-Application
Materials
NCQA PPC-PCMH Overview
•
•
•
•
9 standards; 100 points total
30 elements
10 Must Pass elements
Recognition at three different levels
• Level I: 25 points and 5 Must Pass Elements
• Level II: 50 points and 10 Must Pass Elements
• Level III:75 points and 10 Must Pass Elements
PPC-PCMH Content and Scoring
Standard 1: Access and Communication
A. Has written standards for patient access and patient
communication**
B. Uses data to show it meets its standards for patient
access and communication**
Pt
Standard 2: Patient Tracking and Registry Functions
A.
Uses data system for basic patient information (mostly
non-clinical data)
B.
Has clinical data system with clinical data in searchable
data fields
C. Uses the clinical data system
D. Uses paper or electronic-based charting tools to
organize clinical information**
E.
Uses data to identify important diagnoses and
conditions in practice**
F.
Generates lists of patients and reminds patients and
clinicians of services needed (population management)
Pt
Standard 3: Care Management
A. Adopts and implements evidence-based guidelines
for three conditions **
B.
Generates reminders about preventive services for
clinicians
C. Uses non-physician staff to manage patient care
D. Conducts care management, including care plans,
assessing progress, addressing barriers
E.
Coordinates care//follow-up for patients who receive care
in inpatient and outpatient facilities
Pt
3
Standard 4: Patient Self-Management Support
A.
Assesses language preference and other communication
barriers
B. Actively supports patient self-management**
Pt
4
5
Standard 5: Electronic Prescribing
s A.
Uses electronic system to write prescriptions
B.
Has electronic prescription writer with safety checks
C. Has electronic prescription writer with cost checks
9
2
3
3
6
4
3
21
4
3
5
5
20
2
4
Pts
3
3
2
8
Standard 6: Test Tracking
s A. Tracks tests and identifies abnormal results
systematically**
B. Uses electronic systems to order and retrieve tests
and flag duplicate tests
Pts
7
6
13
Standard 7: Referral Tracking
A. Tracks referrals using paper-based or electronic
system**
PT
4
Standard 8: Performance Reporting and
Improvement
A. Measures clinical and/or service performance
by physician or across the practice**
B.
Survey of patients’ care experience
C. Reports performance across the practice or by
physician **
D. Sets goals and takes action to improve
performance
E.
Produces reports using standardized measures
F.
Transmits reports with standardized measures
electronically to external entities
Pts
Standard 9: Advanced Electronic Communications
A.
Availability of Interactive Website
s B.
Electronic Patient Identification
C. Electronic Care Management Support
4
3
3
3
3
2
1
15
Pts
1
2
1
4
6
**Must Pass Elements
Reading the Standards
Requirements
• Standard
• Intent
• Element A, B, C, etc.
• Factors 1, 2, 3, etc.
• Scoring
Reading the Standards
Requirements
• Data Source
• Explanation
• Examples
– Reports, screenshots, procedures,
worksheets, etc.
Where to start on
Monday…?
Review the requirements for each
standard, element and factor
• What does the practice already do?
• What does the practice need to create?
• Are there elements the practice clearly does not
have in place and that the practice may not
have in the submission timeframe? (eprescribing , Standard 5; or Advanced Electronic
Communication, Standard 9)
Next Steps
• Work on developing practice access
to care and information policies
• Identify three important clinical decisions
– Same three conditions are identified on the application
and for element PPC2E*
– Additional elements related to the three important
clinical conditions: PPC3A* & D; PPC4B*; PPC9C
• Review the standards for what the practice
does not have in place and what they may not
have in place before submitting
Just a reminder…
• Review the elements that require a three
month look back to determine what
process already exist
− Four elements require a 3 month “look
back”
– PPC2C & D*; PPC3D; PPC4B*
• “Must pass” elements require passing at
a minimum at the 50% level
Begin gathering supporting
documentation
• Create a folder (on your server or hard
drive) for documents the practice may
want to attach to the survey tool, by
element
• Develop a checklist of documentation
already used in the practice and
documents that need to be prepared.
Survey Tips
• Upload documents as you finalize them
• 1-2 documents at a time to start
• Permitted file types: .csv, .doc, .gif, .jpg,
.mpp, .pdf, .rtf, .tif, .txt, .vsd, .xls
• Scanned documents are acceptable. Save
as .gif, .tif, .jpg
Who is Recognized?
• Practices that meet the criteria
described in the endorsed principles of
the PCMH
• A physician or group of physicians
practicing together at a single
geographic location
– Recognition is specific to a practice site.
NCQA Tidbits
• Recognition is for 3 years. However….
• Reapplication to improve score can occur
within the 3 year period
• Up to 2 times. Called an “Add on” survey
• “Add on” Survey Fee at the 50% level.
• If Level I is not achieved….
Application Materials
• Must be returned to NCQA prior to
submitting the Interactive Survey Tool
• Minimum of 1 week
• Survey application is complete when
documents have been received by NCQA
and ISS tool has been uploaded.
NCQA Application
Agreement
a) Attestation: Joint Principles
b) Data release
c) NCQA Agreement
d) HIPAA Business Associate Agreement
e) Pricing & payment
NCQA Application Fees
Practice Background
Information Worksheet
• Numbers and names of physicians
• Determines fees
• Verify licensure
• Posting on NCQA website
Three parts to the actual
submission of the application
• Submission of the application and the
appropriate fees
• Submission of the Interactive Survey Tool
• Uploading of the supporting documentation
Questions?