FAQ Directory: Patient-Centered Medical Home (PCMH)

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9.07.2018 Would the annual UDS report, by which FQHC’s are required to submit data to HRSA, be acceptable to provide as a report?

KM 13

For FQHCs that are part of a larger organization with multiple practices under the same umbrella, UDS reporting would not meet KM 13 because the data is at the organizational/corporate level. The data for KM 13 must be at the practice level because recognition is at the practice level. An exception to this is for standalone practices whose UDS data is specific to the practice site location.

8.02.2018 What credentials are required for the care manager?

TC 08

NCQA is not prescriptive regarding which clinical staff it is (clinician, nurse, social worker or other provider) and the practice may determine the training and skills needed to address and manage the behavioral health care needs of their patient population. 

8.02.2018 How do practices account for adolescent confidentiality issues; for example, if an adolescent asks that information not be shared with a parent?

AC 07 (Pediatric Specific)

Pediatric practices are not penalized for not sharing information with parents if the adolescent requests that information not be shared, but applicants must explain the exclusion of adolescent patients in the associated documentation. The system must include only legitimate requests for information based on state and federal confidentiality requirements 
AAP resources:  

Confidentiality considerations in the care of young adolescents, AAP News 2008;29;15: http://aapnews.aappublications.org/cgi/reprint/29/7/15.pdf 

 

8.02.2018 Where can I find an example of a patient care plan for a pediatric patient- centered medical home?

CM 04 (Pediatric Specific)

Care coordination resources, including a sample patient care plan can be found at: https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Care-Coordination.aspx 

National Center for Medical Home Implementation Building Your Medical Home Guide: https://medicalhomes.aap.org/Pages/Managing-Your-Patient-Population.aspxhttps://medicalhomes.aap.org/Documents/PediatricCarePlan.pdf 

NICHQ Care Plan Template: https://www.nichq.org/resource/nichqs-care-plan-template  

7.19.2018 May practices that have not applied for PCMH recognition earn NCQA Distinction in Patient Experience Reporting?

QI 06

No. A nonrecognized practice may submit data to NCQA following the requirements posted on NCQA’s website (http://www.ncqa.org/PublicationsProducts/OtherProducts/PatientExperienceReporting.aspx), but earning distinction requires PCMH recognition.

7.19.2018 Are practices required to use an NCQA-Certified survey vendor to administer CAHPS PCMH?

QI 06

No. Practices only need to use an NCQA-Certified survey vendor if they would like to achieve Distinction in Patient Experience Reporting. Practices that use a survey vendor to administer the CAHPS PCMH survey earn credit for QI 04 A and QI 06 in addition to earning distinction.

7.19.2018 Is NCQA Distinction required for PCMH recognition?

QI 06

No. Practices are not required to have NCQA Distinction in Patient Experience Reporting to earn PCMH recognition.

7.19.2018 What is NCQA Distinction in Patient Experience Reporting?

QI 06

NCQA developed the optional Distinction in Patient Experience Reporting to help practices capture patient and family feedback through the CAHPS PCMH Survey. To earn distinction, practices submit CAHPS PCMH data to NCQA using an NCQA-Certified survey vendor (to ensure a standardized method of data collection and reporting).

7.19.2018 How do practices assess the effectiveness of improvement actions?

QI 12

Assessing effectiveness of improvement actions includes remeasurement to compare results over time and evaluation of what is driving change. Results may be quantitative (numerical data that demonstrate performance and can be compared to benchmarks) or qualitative (conceptual data that describe why performance is high or low), but practices must look at the goals set, actions taken to improve and previous or baseline results.

7.19.2018 When remeasuring to show improvement, what is an acceptable period of time between the initial measurement and the follow-up measurement period?

QI 12

NCQA does not specify a time period required for remeasurement, but it must be long enough for the practice to implement a performance improvement plan and to assess results.

7.19.2018 May practices focus on improving the number of patient experience survey responses it receives back from patients?

QI 11

No. A measure looking to increase the number of patients who complete the satisfaction survey would not meet the requirement. Practice should look at improving an area identified using the patient experience data collected in QI 04.

7.19.2018 What type of qualitative data and feedback meet this requirement?

QI 04B

Practices may collect qualitative feedback through a suggestion box in the waiting room, by hosting focus groups or by conducting individual patient interviews. Practices can also meet the requirements of QI 04B if they have a patient advisory council and encourage feedback on patient satisfaction issues on the council agenda.