No, practices are not required to use an NCQA-Certified survey vendor.
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5.29.2018 QI 06 Are practices required to use an NCQA-Certified survey vendor to administer CAHPS PCMH?
5.29.2018 CM 07 Are practices required to document that they assess and address patient barriers to meeting treatment goals?
Yes. Practices must assess whether there are barriers to meeting goals and should address any identified barriers. Both components must be listed in the medical record in order to select “Yes” in the Record Review Workbook. If the practice assesses potential barriers and none are identified, the practice may answer “Yes.”
Note: Practices must provide an example of how they meet each criterion and complete the Record Review Workbook. Examples are not required if a practice provides a report as evidence.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 04C Our PCPs and specialists use the same integrated EHR. Do we need to show tracking and follow-up?
Yes. Practices that use integrated systems must demonstrate how specialists are notified of a referral request and how the referral status will be tracked (including the specialist’s report). Even if the same EHR is used by both the primary care practitioner and the specialist, evidence must clearly demonstrate how the requirements are met within the system.
This applies to the following Programs and Years:
PCMH 20175.29.2018 QI 04 Can the practice choose to show reports from either quantitative data or qualitative data?
5.29.2018 CC 06 & CC 07 May a practice use credentialing information to meet CC 06 and CC 07?
No. Credentialing—although important to a clinician’s ability to practice—is not a specific indicator of performance or quality information. Practices must use performance data to evaluate the quality of specialists or consultants to whom they send patients. Performance data can be qualitative or quantitative and may be gathered from external reporting sources (e.g., PCSP recognition, CMS public reporting) or may be internal based on criteria defined by the practice (e.g., evaluating a specialist’s timeliness in returning referral reports, evaluating whether patients had a positive experience).
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 08 What is an example of an informal agreement?
An informal agreement could be a few sentences in a referral form, e-mail or other method of communication containing expectations for the specialist, including, but not limited to, the time frame for reporting to the primary care physician and specifying lab or test results that should be included in the report. This information is essential to clarify the relationship between the primary care provider and specialist.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 14 Do hospitalization and ED visit data from the health plan meet the requirements of this criterion?
A practice may use health plan data to identify patients if it is provided at least weekly and if at least 75 percent of the patient population is represented by the health plan. The practice may use data from more than one health plan as long as the plans collectively represent at least 75 percent of the practice population.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 21C How do practices demonstrate capability for electronic exchange of key clinical information with facilities?
5.29.2018 CC 12 How do practices document co-management arrangements?
The practice must demonstrate at least three examples demonstrating co-management arrangements, such as de-identified referral forms that include the arrangements or sections of the medical record specifying the clinician responsible for each component of care. For example, for a diabetic patient who is referred to a medical oncologist, the arrangement would identify which clinician manages the diabetes and which clinician manages the side-effects of the oncology treatment and their expectation for timely sharing of patient information.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 14 Are practices required to show they can identify all patients who have been admitted to the hospital and treated in the ED?
No. Practices are not required to identify all patients admitted to the hospital or ED, but they must have a process for identifying patients admitted to facilities used most often by their population. In addition to a documented process, practices must also submit a log or report demonstrating that patients were identified.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 08 Our practice is part of an integrated health system. Do we need to show agreements between primary care providers and specialists?
Yes. Practices must have an agreement or documented process outlining the responsibilities of the referring provider and the specialist, even in an integrated system. It is essential that each provider understands the expectations and responsibilities of the referral, including the frequency and methods of communication.