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The “medical home” has been an innovative concept that has kept the patient at the center of care while streamlining clinical processes and optimizing workflow. The recognition program set by NCQA (National Committee for Quality Assurance) forces practices to adopt practices and procedures that improve quality and efficiency of care. Case studies of how we have helped practices achieve Medical Home are at the end of the page.
The process to come a PCMH recognized practice can lead to increased reimbursement but is often difficult, confusing and frustrating. Our consultants will transform this process to one that is rather pleasant, cost-effective and readily achievable.
NCCQ (National Committee for Quality Assurance) and JCAHO (Joint Commission for Accreditation of Hospital Organizations) are the 2 organizations that provide certification for PCMH. Although there is not a penalty for not achieving PCMH (like that from the Medicare Meaningful Use Program), becoming a recognized practice from either one of these organizations has proven to improve patient care quality, safety, enhance marketing for the practice and increase reimbursement from certain payers. PCMH guidelines foster the use of health IT.
Patient Centered Medical Home is built on guiding principles such as:
- Each person having a personal physician
- Administering whole-person care (addressing not only physical but psychosocial aspects)
- Care coordination across healthcare organizational boundaries
- Physician directed team approach to care
- Enhanced Quality and Safety through using Evidence Based Medicine guidelines, streamlined protocols, robust data collection and reporting, and empower patients to take part in their care
We currently provide assistance with achieving recognition for the NCQA 2011 Standards. Specific benefits of recognition include:
1) Possible increased payment from certain payers (ie. NC BCBS program where rate can be up to 180% of a medicare 99213 code)
2) NCQA certificate to hang in practice waiting room and logos for website/front door
3) Higher quality, improved safety and more cost-effective, efficient care for patients
The costs of applying for PCMH include (perceived greatest to least impact):
1) Some staff time
2) Workflow change
3) Minimal NCQA application investment, ranging to less than a few hundred dollars
Specifically, our consultants can help with:
1) Determining whether PCMH certification matches your practice goals and is a positive ROI (return of investment)
2) Determining your eligibility for PCMH and registering your practice
3) Ensuring compliance with recognition requirements with assistance in workflow re-design, protocol/policy development, using the EMR to collect the appropriate data for reporting
4) Implementation of new workflows, policies and facilitating organizational change
5) Helping with filling out the NCQA survey tool and attesting answers
6) Facilitating interaction with payers in order to receive increased reimbursement due to recognition
7) Aligning PCMH criteria with other initiatives (as much as possible) that your practice may be involved with such as Meaningful Use, Physician Quality Reporting System(PQRS) or NCQA Diabetes Recognition Program (DRP), in order to maximize efficiency and use of resources.
In the first quarter of 2013, NCQA has come out with a Patient-Centered Specialty Recognition Program. This is the medical home version for specialists. Similar to PCMH recognition, practices are required to register and attest to meeting several criteria in order to receive recognition. AHS consultants know these measures and are starting to help practices successfully attest and reap the benefits of this recognition. Please contact us for further details.
Case Studies on how AHS helped practices with PCMH implementation
(For measure 4/A/2, MUST PASS) Clinic XYZ had an EMR that was unable to produce reports with a denominator having the patients with important conditions and high risk conditions (PCMH 3 A &B). The patient education meaningful use report only produced a denominator with all eligible patients. AHS devised a smart excel template that could work with ICD-9 frequency reports, already a function of the Client’s EMR system, to pick up the number of patients under 3 A & B and also determine from the numerator only those eligible for patient education handouts.
(For measure 3/C/1-7, MUST PASS) Organization ABC, like all others, hasn’t had a need to record that for all patients seen for diabetes, hypertension, tobacco cessation and moderate persistent asthma (3 important conditions and high risk condition) self-management, medication reconciliation or developing an individual care plan in order to be compliant with a payer or government mandate. Now, this element requires this to be part of the note for at least 48 patients as recorded in the Records Review Workbook or else ABC can’t obtain medical home recognition. AHS devised verbiage for the existing templates used by different providers for the patients with the above conditions. Also, we suggested a workflow pattern such that the providers would remember to use these modified templates regularly so that the 48 patients needed were easily obtained. All of this was done with very little to virtually no disturbance to the providers’ workflows and documentation styles.
To learn more, call us today at (919) 228-8744 or email us at firstname.lastname@example.org