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
FAQ Directory: Patient-Centered Medical Home (PCMH)
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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?
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
5.22.2018 AC 02 Are practices required to provide a minimum number of same-day appointments?
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.
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 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.
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?
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?
5.22.2018 AC 02 Are practices required to reserve separate same-day appointment slots for routine and urgent visits?
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:
- 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?
- How often do you need to assess the access needs of your patients?
- What variables may impact changes in the use of appointment types?
- 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.
- Do the questions on your survey ask patients directly about their access needs or preferences?
PCMH 2017
5.21.2018 TC 09 How can practices demonstrate that they provide access to evidence-based care?
Information about care can be provided to patients through materials such as brochures, flyers or information posted on the practice’s website. When describing the services provided by the practice, attention should be drawn to defining evidence-based guidelines for preventive and clinical care.
PCMH 2017