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PCMH: FAQs

What is a Patient-Centered Medical Home (PCMH)? 

A PCMH puts patients at the forefront of care by building better relationships between people and their clinical care teams. Research shows that PCMHs improve quality, reduce costs and improve both practice staff and patient satisfaction. The National Committee for Quality Assurance (NCQA) helps primary care practices transform into PCMHs through its recognition program. 

The American Academy of Pediatrics introduced the medical home concept in 1967, and in 2007 leading primary care-oriented medical professional societies released the Joint Principles of the PCMH. The next year, NCQA released its PCMH Recognition program, the first evaluation program in the country based on the PCMH model. Today, NCQA’s PCMH Recognition program has evolved to feature a set of six concepts that make up a medical home. Underlying these concepts are criteria (activities for which a practice must demonstrate adequate performance to obtain NCQA PCMH Recognition) developed from evidence-based guidelines and best practices. 

How are the criteria developed? 

The concepts and criteria in NCQA’s PCMH Recognition Program are built from the PCMH model and evidence-based best practices. The final program requirements are developed with input from the PCMH Advisory Committee and Clinical Programs Committees. The Advisory Committee includes representatives from medical practices, medical associations, physician groups, health plans and consumer and employer groups. The committee meets and analyzes draft concepts and criteria and PCMH Recognition data. Draft concepts and criteria get released publicly and a public comment period allows for feedback. These comments from practices like yours are considered in drafting the final concepts and criteria. 

What are the benefits of the program? 

NCQA PCMH Recognition can help you improve the quality of care provided and reduce health care costs. In addition, PCMHs lead to happier patients and staff. You can see published evidence about how PCMHs impact quality and cost here, or learn more about benefits to your practice and patients here

How do I become recognized? 

Step one is to download the program requirements. After you review the requirements, perform a gap analysis of your practice and identify where you might need to transform. Once you start applying changes to your practice, you can enroll in NCQA recognition through the Q-PASS system. Over time, you will have check-ins with NCQA to evaluate whether you meet the criteria in the program. You can learn more about the process for getting recognized here

What are the requirements? 

The PCMH standards and guidelines document contains PCMH Recognition program requirements and information your practice needs to demonstrate to NCQA that you meet criteria. Refer to the PCMH concepts and criteria within this document, available for free download from the NCQA store. In this publication, you will find table with the criteria and what evidence is needed to submit to NCQA to earn recognition. Learn more about the concept areas

How much does recognition cost? 

The cost for recognition depends on how many practice sites and clinicians you have. See more about pricing

When do I pay for recognition?

You pay for your recognition at the time of enrollment. 

What are my payment options?

You can pay by credit card or electronic check through the Q-PASS system. You can also pay via paper check, if necessary. 

Where can I get a copy of the Standards & Guidelines document? 

The Standards & Guidelines document is the publication that contains the requirements for recognition. You can download this document for free through the NCQA store. You can always know the latest version of documents by going to ncqa.org/documents

Is the Recognition for practices or clinicians?

Recognition is earned at the practice level. A clinician within a practice that earns NCQA PCMH Recognition will be listed in our online directory of clinicians. However, if a clinician leaves that practice they cannot take that Recognition status with them – it is for how the practice operates. 

How do you define an eligible practice? 

An eligible practice consists of one or more clinicians (including all eligible primary care clinicians) who practice together and provide primary patient care at a single geographic location. “Practicing together” means that all the clinicians in a practice: 

  • Follow the same procedures and protocols. 
  • Have access to (as appropriate) and share medical records (paper and electronic) for all patients treated at the practice site. 

Electronic and paper-based systems and procedures support clinical and administrative functions (e.g., scheduling, treating patients, ordering services, prescribing, maintaining medical records and follow-up). 

How do you define an eligible clinician? 

  • Clinicians who hold a current, unrestricted license as a doctor of medicine (MD), doctor of osteopathy (DO), advanced practice registered nurse (APRN), or physician assistant (PA). 
  • Only clinicians who can be selected by a patient/family as a personal clinician are eligible to be listed, in addition to the practice Recognition, on NCQA’s Web site. 
  • The practice can define a “personal clinician” as: o A residency group under a supervising clinician or faculty physician (residents are not identified individually for selection as personal clinicians). o A combination physician and APRN or PA who share a panel of patients. 
  • Physicians, APRNs (including nurse practitioners, clinical nurse specialists) and PAs who practice internal medicine, family medicine or pediatrics, with the intention of serving as the personal clinician for their patients. These clinicians will be identified individually with the recognized practice. 
  • Physician-led practices applying with identified APRNs or PAs: 
    • Patients may choose the APRN or PA as their primary care clinician, or 
    • ARPNs or PAs share a panel of patients as a primary care team with the physician. 

Will you visit my site as part of the recognition process?

NCQA does not incorporate an on-site visit, but does incorporate virtual reviews, so you will have online virtual reviews with an NCQA Evaluator that can give you feedback in real time.

I’m involved in other initiatives, how will this impact those? 

We realize that there are a lot of demands on practices. That’s why we worked with practices and clinicians to in developing the requirements. NCQA tried to align requirements in the PCMH program with what is required in other major initiatives and to support where health care is headed. In addition, NCQA requirements are flexible. We provide a framework for what a medical home should look like, but want you to apply changes in your practice that meet the needs of your community and your patients. 

How will recognition impact my reimbursement rates? 

Talk to payers with which you contract prior to, during and after achieving NCQA Recognition to let them know about how you are transforming your practice. Many payers have initiatives that help support PCMH transformation or help you achieve higher reimbursement. In addition, NCQA Recognition can benefit you in Federal programs. For example, becoming an NCQA-Recognized PCMH or PCSP directly increases clinician payments through the Merit-Based Incentive Payment System (MIPS) in MACRA. NCQA keeps an updated list of payer initiatives on its web site.