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Recognition Redesign: Frequently Asked Questions 

We support continuous improvement. 

First and foremost, the redesign responds to your feedback. Practice staff, clinicians and Certified Content Experts (CCE) recommended many of the changes. They told us to improve the process, to cut back the paperwork, to simplify reporting. They told us they wanted more time to concentrate on care. 

We also considered the changing payment climate. Recent changes in federal law—the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—will change payments to reward value-based care. Our redesigned process aims to align reporting requirements with expected MACRA changes, to eliminate duplication of work. 

NCQA also worked with numerous organizations that certify clinicians. Now, in many cases, NCQA PCMH Recognition will provide credit toward clinicians’ maintenance of certification (MOC). 

The following feedback about the current PCMH Recognition Program helped shape the redesign: 

  • The current recognition process can be too difficult for smaller practices.
  • There needs to be less emphasis on process and more emphasis on performance.
  • There is too much documentation required.
  • Practices want more and ongoing interaction with NCQA representatives.
  • Practices should be demonstrating ongoing quality improvement and ongoing implementation of PCMH principles.
  • There should be more education and guidance for practices.
  • It requires practices to use two separate, complicated tools. 

The redesigned program—to be launched March 31, 2017—includes ongoing, sustained recognition status with annual check-in and reporting instead of the current program’s three-year recognition cycle. 

 The process offers: 

  • Flexibility. Practices take the path to recognition that suits their strengths, schedule and goals. 
  • Personalized service. Practices get more interaction with NCQA, and are assigned an NCQA representative who works with them throughout the recognition process and is a consistent point of contact. 
  • User-friendly approach. Requirements remain meaningful, but with simplified reporting and less paperwork. 
  • Continuous improvement. Annual check-ins help practices strengthen as medical homes. By reviewing your progress more often, we hope to keep performance improvement at the top of your priorities list. 
  • Alignment with changes in health care. The program aligns with current public and private initiatives and can adapt to future changes.   

What does the redesigned process look like? 

The new recognition process has three parts: 

  • Commit. The practice completes a self-assessment before committing to transformation and the recognition process. When the practice commits, it works with the assigned NCQA representative to conduct an online assessment and develop an evaluation plan and schedule. 
  • Transform. Practices gradually transform, building on successes. During this time, they show their progress by submitting documentation and data to NCQA through a new system designed to reduce paperwork and administrative hassles. Along the way, NCQA conducts virtual reviews—online check-ins—with the practice to gauge progress and to discuss next steps in the evaluation. The virtual check-ins, which are conducted online via screen sharing technology, provide practices with immediate and personalized feedback on what is going well and what needs to improve. Evaluation is now more educational and collaborative. 
  • Succeed. The practice continues to implement and enhance its PCMH model to improve how it meets the needs of patients. Each year, the practice checks in with NCQA to show that its ongoing activities are consistent with the PCMH model of care. The annual check-in includes attesting to certain policies and procedures and submission of key data. This process will sustain the practice’s recognition. Better yet, it’s designed to foster continuous improvement. That means the practice succeeds in strengthening its transformation, and as a result, patient care. 

Here is a detailed timeline of the process—your activities and ours.   

How will the recognition program change, fundamentally? 

The underlying principles of PCMH remain the same. Evidence shows that the PCMH model of care can result in reduced costs and healthier and more satisfied patients. The redesigned process focuses more on performance and quality improvement, and aligns with many other major national initiatives that impact practices, such as MACRA. 

 The recognition process is changing. Recognition is just that. NCQA recognizes the practice for showing it is transforming to deliver better care and better outcomes for patients. 

How does the redesign align with MACRA? 

MACRA changes how eligible clinicians get paid under Medicare—transitioning from volume to value—and takes a big step forward for health care quality. CMS rules detail how Medicare will implement MACRA’s Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).

On the MIPS track, clinicians will get bonuses or penalties based on their performance in four measure areas: Quality; Advancing Care Information (formerly Meaningful Use); Clinical Practice Improvement Activities (CPIA); Resource Use Measures. 

Clinicians in practices that earn NCQA Recognition will automatically get full credit in the CPIA category. And evidence shows operating as a PCMH can lead to better performance in other categories. 

How will the redesign help practices save time? 

One goal of the redesign is to reduce required documentation making it easier for practices to show how they meet PCMH recognition requirements. The online reporting platform and virtual check-ins are designed to reduce paperwork and reduce the amount of time practices spend showing their progress. And because practices will check in with NCQA at least three times during the initial process, any unforeseen reporting requirements are less likely than in the prior process. The virtual reviews provide practices with feedback as they continue to transform, giving them a chance to make course corrections. Finally, annual check-ins to sustain recognition mean that practices submit vital quality improvement data annually, but no longer have to spend as much time gathering documentation to renew recognition status. 

 NCQA worked with pilot practices to test this new process. Pilot practices saw a significant amount of time saved documenting and submitting information for recognition. 

How does the new online system work? 

Many recognized practices said that the current process of using two complicated tools (systems) could be improved. In response, NCQA designed a new online system that: 

  • Creates one location for practices to house survey-related documentation and information, as well as practice-site demographics and contact information. 
  • Is intuitive and uses tips to make the process easier. 
  • Supports collaboration between practices and their consultants. 

The application and recognition process will merge on a new software platform that encourages practices, consultants and NCQA to communicate. Reviews will take place on line throughout the recognition process. After practices earn initial recognition, they report annually to confirm that they continue to meet requirements.

When will the new online system be released?

The new online system will launch with the new program on March 31, 2017. However, we will have previews of the new system as we get closer to launch. Be on the lookout for more information on the system in early 2017.

Will the redesigned program incorporate new requirements?

Requirements are updated annually now. Historically, NCQA updated requirements every three years. NCQA is releasing PCMH 2017 at the same time it is launching its new recognition process. Practices that have achieved PCMH 2014 Level 3 recognition may transition directly to Succeed, the sustaining part of the new recognition process. 

Information for Practices Seeking First-Time Recognition 

My practice is not yet recognized, but wants to become recognized under PCMH 2014. Is that an option? 

Yes. If you are currently preparing to come through recognition, you may do so under PCMH 2014. Once your three-year recognition concludes, you will transition to the new process. Practices that choose this option must submit their site survey by September 30, 2017. Other key dates in 2017:

Redesigned process and 2017 standards become available March 31
Last day to purchase PCMH 2014 survey licenses March 31
Last day to submit PCMH 2014 Corporate Survey May 31
Last day to request PCMH 2014 Add-On Surveys June 30
Last day to submit PCMH 2014 Corporate Add-On Tools July 31
Last day to submit all PCMH 2014 Site Surveys September 30




 

 
Remember: The new process and platform are only available to practices seeking recognition under PCMH 2017.

Our practice is in the process of pursuing PCMH 2014 recognition. Should we hold off until the redesign is released?

No! Practices currently pursuing PCMH 2014 recognition will earn the three-year recognition and then move to the annual reporting process. They may choose to transition to annual reporting earlier than in three years, but must achieve Level 3 recognition in order to transition directly to the “Succeed” stage of the PCMH 2017 process.

See more information on moving from PCMH 2014 to the redesigned process.

Information for Currently Recognized Practices

My practice is currently recognized. What are my options for moving to the new process?

Currently recognized practices have the option to renew or convert under PCMH 2014 (if they submit site surveys by September 30, 2017), or they may transition to the new recognition process, which applies only to those seeking PCMH 2017 recognition.

Practices do not have to make a decision until they approach the end of their current recognition period. NCQA recommends that practices begin to weigh the options 6–9 months before their recognition expires.

Learn more about your options:

Information for practices recognized under PCMH 2011

Information for practices recognized under PCMH 2014

Succeed: Sustaining Your Recognition

What is expected at annual check-ins?

Practices use the online platform to submit documentation that supports reporting requirements at their annual check-in; NCQA reviews documentation and notifies practices of their recognition status. Recognition is based on a practice’s overall performance across six categories. Practices must meet the minimum number of requirements for each category. NCQA will select practices randomly for audit to validate submitted documentation and data.

Practices will demonstrate they continue to align with recognition requirements by submitting data and documentation on these six critical aspects of PCMH:

  • Patient-centered access.
  • Team-based care.
  • Population health management.
  • Care management.
  • Care coordination and care transitions.
  • Performance measurement and quality improvement.

Will the standards for documentation and reporting change every year? How far in advance will practices be notified about information they must submit?

NCQA expects to introduce new requirements when needed to strengthen your transformation. Reporting updates may include new requirements or may modify or eliminate existing requirements. We expect to base many of these updates, like the redesign, on your feedback and the latest research that works. Annual reporting updates will be available within six months before they are scheduled to take effect.

How will NCQA collect PCMH 2017 practice quality data? How about through a data feed, rather than a document upload?

NCQA expects to introduce an optional path for practices to report electronic clinical quality measures directly or through a third party (e.g., EHR vendor, health information exchange, qualified clinical data registry) in 2017.

For the annual reporting requirements, may practices choose different requirements to report on from year to year?

Some requirements will apply to all practices, but in some cases, practices will choose from a set of reporting options. Practices may change what they report from year-to-year, as long as it is within the set of options.

Pricing and Payment

What is the price for the Redesigned recognition process?

The price varies by the number of clinicians within your practice, and the number of practices within your organization. View the new pricing structure here.

When is payment due?

For practices seeking recognition for the first time, the recognition fee is due at enrollment. Thereafter, recognition fees are due when the practice conducts its yearly check-in.

What methods of payment are accepted?

For your convenience, NCQA accepts payment electronically with either your credit card or a check. 

Additional Questions

Are NCQA metrics aligned with CMS, AHIP and NQF Core Quality measures?

Yes. Many NCQA metrics are aligned with other measures. NCQA identified a set of 35 measures that come from the CMS Meaningful Use program. A collaborative led by AHIP recently identified 22 PCMH/ACO measures. Thirteen are in the NCQA set; the 9 remaining measures have not been specified electronically, are for health plans or are survey measures.

How does NCQA plan to support and promote the use of Certified Content Experts (CCE) in practices?

NCQA’s new process and platform are designed to include CCEs. CCEs who act as consultants will be able to monitor, review and assist practices throughout the transformation and recognition process using our new online platform.

I’m a consultant who works with many practices. How can I access the new online system?

Consultants will have one login that will let them access the surveys of all practices for which they are designated an authorized user.

Is there a forum available for sharing best practices among groups that have achieved or are seeking PCMH recognition?

Yes. Start with one of NCQA’s numerous education programs listed on our Education webpage. NCQA also hosts periodic Webinars, live seminars and CCE training. We recommend the PCMH Congress as an outstanding resource for learning about others’ experiences and for getting advice on best practices. In addition, our CCE community is available to share its expertise on NCQA’s new education platform, Strategies for Success as a PCMH. Go to My NCQA to create an account (if you don’t have one already). After you log in, click the appropriate program on the MyApps page.

What if a practice misses the annual check-in or does not meet requirements?

If a practice misses the annual check-in or does not meet requirements, its recognition status will be suspended. The practice has the opportunity to correct deficiencies or submit missing annual reporting within 90 days of the check-in date, to have the suspension lifted.

If the practice does not complete reporting requirements by the end of the 90-day period, it loses recognition status. Even then, recognition may be reinstated if within 9 months the practice corrects deficiencies, submits reporting and participates in a limited review process with an evaluator. If it does not, the practice must start the recognition process from the beginning.

What if a practice has more clinicians than it indicated when it paid the recognition fee?

Practices state the number of clinicians when they commit to pursuing recognition and pay the recognition fee. At the end of transformation, NCQA will reconcile what the practice paid with how many clinicians are associated with the practice. If there are more clinicians in the practice, the practice pays the difference to NCQA.

Will requirements still be released every three years?

One goal of this new program is to adapt to the needs of the health care system more quickly and efficiently. Therefore, NCQA may make relatively small updates to standards each year, instead of making many changes every three years. NCQA will release updates at least six months before they take effect, to give practices time to comply.