No. The ACFP tool is a helpful resource for practices to use when considering and managing panel sizes. If the practice prefers to use another method that is perfectly acceptable if it performs the same function.
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5.22.2018 AC 13 Is it mandatory to use the American College of Family Physicians mentioned in the guidance for determining panel sizes?
5.22.2018 AC 02 Are practices required to measure their capacity to see patients or to measure the utilization of same-day appointments (i.e., number of patients seen)?
Practices are expected to show both availability (i.e., open appointment slots at the beginning of the day) and use of same-day appointments for a period of five consecutive days. Practices should also monitor the availability of same-day appointments against their documented process. Practices may use utilization of same-day appointment access as an indication of patient need.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 03 May practices refer patients to an associated urgent care site or facility for care outside regular business hours?
Yes. Practices may refer patients to associated urgent care sites or facilities (i.e., facilities with which the practice has a relationship or an agreement to work together) to meet AC 03, but must provide a documented process demonstrating how patients are referred to facilities for scheduled routine and urgent appointments. The facility must have access to patient medical records outside regular business hours.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 06 Our practice has a contract with a telehealth company that provides primary care to patients when they cannot come into the office. Does this meet the requirement for an alternative clinical encounter?
5.22.2018 AC 12 Our practice offers night and weekend clinical advice coverage to patients through a phone service staffed by RNs. Does this meet the requirement for access to clinical advice?
5.22.2018 CM 01A Does tobacco use count as a behavioral health condition?
No. Tobacco use is an unhealthy behavior and is not considered a behavioral health condition. Practices need to identify behavioral health-related criteria pertinent to their specific patient population, which could include other (non-tobacco-related) substance use treatment, a behavioral health diagnosis, a positive screening result from a standardized behavioral health screener or psychiatric hospitalizations.
This applies to the following Programs and Years:
PCMH 20175.22.2018 CM 01 What’s the difference between CM 01 and CM 03 as both look at identifying high risk patients?
CM 01 focuses on the practice’s established criteria and systematic process for identifying patients in need of care management. Comprehensive risk stratification in CM 03 requires a more complex identification process than that of CM 01. CM 03 goes beyond simply establishing criteria and provides elective credit to practices that are using a risk assessment process to identify patients for care management, leveraging clinical data about the patients; it is about stratifying patients using all the factors that put the patient at higher risk and in need of assistance in managing their health. If a practice meets CM 03, it will automatically meet CM 01.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 08 Our patient portal has a message telling patients that the office will respond to requests for clinical advice on the next business day and that patients should contact the on-call provider if the office is closed. Does this meet the requirement?
Yes. The requirement is met if the response time is documented when a patient submits an electronic request for clinical advice and the practice communicates to patients that an on-call provider is available to address urgent issues by telephone after hours. Practices must have a documented process for addressing electronic advice and telephone advice; for this criterion, practices may submit a report tracking response times to electronic requests for at least seven days during operating hours and after hours.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 06 A behavioral healthcare practitioner is integrated with our practice and provides telepsychiatry visits. Does this meet the requirement for an alternative clinical encounter?
Yes. NCQA accepts telepsychiatry visits as an alternative clinical encounter if the behavioral healthcare practitioner is at least partially integrated with the practice site (i.e., sharing at least partial access to the same systems and patient records).
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 10 How should residency clinics handle clinician selection?
Residency clinics should give patients the option to choose a care team that is under the direction of a staff or supervising physician. The personal clinician would not be a resident because the resident will no longer be associated with the clinic when their residency ends.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 11 Urgent care visits or visits during extended hours may not be available with a patient’s primary care clinician. Does NCQA require a particular percentage of visits must be with a selected primary care clinician?
5.22.2018 AC 11 What does NCQA mean by a goal must be set? Are there specific parameters on what the goal must be?
The practice should set its own goal for continuity of patient visits with their selected primary care provider or care team and then monitor that percentage to evaluate its performance. The practice should set goals such as by percentage, number of visits, etc. for the frequency patients should be seeing their selected provider and then monitor to see how frequent they are meeting their goal. The practice should provide its report including the rate of visits for patients with their provider including the goal established.