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If a PA or an APRN shares a panel of patients with a physician then that team would be considered a solo site since all patients are assigned to the primary provider with a single panel.
If the PA or APRNs that have their own panel of patients and can be selected as a patient’s primary care clinician, the site would not be considered a solo site.
By “regular business hours,” NCQA means 8 am-5 pm, Monday-Friday. The practice determines its hours of operation. Offering appointments between 7am and 4pm meets the criterion. The intent is that practices provide appointments outside typical business hours, to accommodate patients’ access needs. A practice could also shift staff hours—some staff work from 7 am-4 pm weekdays; some staff work from 8 am-5 pm weekdays—to enhance access.
Reports submitted for QI often outline a lot of information (baseline performance, goals, actions, and remeasurements) that must be carefully reviewed. By uploading the documents ahead of the virtual review, it gives the Evaluator time to review the data and note areas for clarification.
The evidence must specifically reflect the practice’s patient population. Standalone practices whose PFAC only includes patients and family members from the practice may use it to meet QI 04B. For practices that are a part of an organization with other primary care practices under the same umbrella, a shared PFAC would not meet QI 04B. While an organization with a shared PFAC in most cases cannot use it as evidence for QI 04B, it may be used it to demonstrate shared evidence to meet elective criteria TC 04 (2 credits) and QI 17 (2 credits).
No, increasing survey response rate is important in obtaining more representative patient feedback, but would not meet the intent of QI 08 or AR QI 03. The response rate is part of the platform for obtaining the feedback, while the measure for these criteria should be improving the feedback itself.
No, neither secure, electronic fax noR secure email would meet the intent of CM 09. For CM 09, the practice must demonstrate its capability to make their patient's care plans available securely to other care settings, such as hospitals, specialists, or other care facilities that could be managing patient care. This availability should be at the time the patient is seen, including after hours, and as such should not involve reaching out to the practice for the information to be sent. The way in which this care plan is shared may vary and NCQA is not prescriptive, but examples include sharing care plans via shared medical records, HIEs or other shared systems that enable staff from different care settings to view the patient's care plan for continuity and optimal care coordination while the patient receives care from multiple settings.
Participating in an HIE can help practices demonstrate PCMH criteria; however, connection alone does not demonstrate the evidence needed to meet the following criteria. Practices must demonstrate how they use the HIE to meet each criterion. Utilization of an HIE could help meet the following criteria:
|
PCMH Criteria |
NYS PCMH |
|
|
AC 12(2 Credits) |
Continuity of Medical Record Information |
✔ |
|
CM 09(1 Credit) |
Care Plan Integration |
✔ |
|
CC 15(Core) |
Sharing Clinical information |
|
|
CC 17(1 Credit) |
Acute Care After-Hours Communication |
|
|
CC 18(1 Credit) |
Information Exchange During Hospitalization |
|
|
CC 19(1 Credit) |
Patient Discharge Summaries |
✔ |
|
CC 21(Maximum 3 Credits) |
External Electronic Exchange of Information |
✔ |
SDOH Roadmap
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A practice with integrated behavioral health may provide its documented process and evidence of implementation. For evidence of implementation, the practice might demonstrate the practice's internal process for entering patient treatment notes, referral guidance and medication management within its system and how the integrated BH provider updates the PCP about the patient's progress. The documented process may also include how the practice facilitates transition to BH, such as through warm handoffs.
Yes, collection of qualitative data through reviews on Google, Yelp, Facebook, Health Grades, etc. may be used as data for QI 04B if the practice actively notifies patients of the availability of those sites to submit patient experience information. If the sites are not actively advertised and not all patients are aware and represented, it would not meet the intent of the criteria.
The list should include the specialist office names or specialist's names in addition to their specialty types. The intent of CC 06 is for the practice to monitor its referral patterns and identify areas where it might improve care coordination (e.g., identifying clinicians most commonly referred to and ensuring that communication expectations are established for the relationship with those providers, like for CC 08). This criterion requires that the practice demonstrate how it monitors referral patterns, which could be a report showing referral trends.
