FAQ Directory: Patient-Centered Medical Home (PCMH)

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5.22.2018 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?

No. NCQA does not prescribe a percentage, nor does it expect patients to be seen by their selected primary care clinician for a specific percentage of visits.
 

PCMH 2017

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?

Yes, if the phone service can provide after-hours access (AC 04) and can access the patient’s medical record either directly or through an available on-call provider with direct access (AC 12).
 

PCMH 2017

5.22.2018 AC 13 Is it mandatory to use the American College of Family Physicians mentioned in the guidance for determining panel sizes?

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.
 

PCMH 2017

5.22.2018 AC 01 What are examples for how and where practices should collect data to address AC 01?

The intent of AC 01 is to assess the access needs and preferences of the practice’s patient population. To identify the best way to obtain this information, practices may need to review how they are currently collecting patient feedback on access needs. For example, a patient survey may ask patients if they are able to get an appointment when needed; however, that question doesn't tell you when patients want to access the practice. The practice may be offering access when the majority of patients don't or aren't able to utilize it.
Practices should collect and assess the feedback from patients to see if there's a need to adjust the access provided to patients. Some questions to   consider include:

  1. What data are you already collecting on patient access (e.g. surveys, use of appointments)? Is it current and does it cover the whole patient population?
  2. How often do you need to assess the access needs of your patients?
  3. What variables may impact changes in the use of appointment types?
  4. If using patient satisfaction surveys, how many patients are actually responding? If the response rate is low, is there another mode of collecting feedback to get more input.
  5. Do the questions on your survey ask patients directly about their access needs or preferences?

PCMH 2017

5.22.2018 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?

Yes, this meets the requirement if the telehealth provider is a clinician, provides a scheduled appointment and has access to practice systems and the patient’s medical record.

PCMH 2017

5.22.2018 AC 07 Does a link to the practice’s Web page showing available practice activities meet the requirements for AC 07?

Documentation may be a screen shot demonstrating system capability. This could be multiple screenshots (one of the Web portal page and screenshots for each item) or one screenshot showing evidence of multiple capabilities required (requesting medication refills, appointments and requesting a referral or test) on an active website. Practices are also encouraged to demonstrate these capabilities with their evaluator during their virtual check-in.

PCMH 2017

5.22.2018 AC 08 How does NCQA define “timely” phone or e-mail clinical advice? Are practices required to document response time?

Practices define “timely” advice after considering the needs of their population. Practices must submit their written policy for responding to calls and e-mails, which may categorize the types of requests and appropriate response times.
Practices must also monitor and demonstrate their documented process defining response times to a nonurgent message and a report summarizing response times.
 

PCMH 2017

5.22.2018 AC 02 May practices block nurse practitioners’ schedules for same-day appointments?

Yes. Practices may use nonphysician members of the clinical care team, such as nurse practitioners or physician assistants (PA) who have their own panel of patients, for same-day appointments. There is no requirement for all clinicians to have same-day appointment slots available every day.

PCMH 2017

5.22.2018 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.

PCMH 2017

5.22.2018 AC 03 We are a hospital-owned practice; the ED serves as an after-hours clinic. Does this meet the requirements?

No. AC 03 requires practices to offer appointments outside regular business hours for both routine and urgent care. Using the ED for after-hours care does not meet the requirement since patients cannot schedule and access routine appointments at the ED.

PCMH 2017

5.22.2018 AC 06 What are “alternative clinical encounters”?

“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:

  • A scheduled telephone clinical visit.
  • A scheduled clinical video chat visit.

PCMH 2017

5.22.2018 AC 06 Can a nurse be scheduled for an alternative appointment with a patient?

Yes, members of the clinical staff (including clinicians and nurses) providing clinical care to patients (based on pertinent licensing laws) may be scheduled for an alternative appointment with a patient. These appointments are in place of those scheduled in the physical office and provided by telephone or other technology supported mechanisms. Visits with social workers, nutritionists, educators or pharmacists alone without an accompanying staff member administering clinical care would not meet the intent of the criterion.

PCMH 2017