FAQ Directory: Patient-Centered Medical Home (PCMH)

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5.29.2018 CM 07 Are practices required to document that they assess and address patient barriers to meeting treatment goals?

Yes. Practices must assess whether there are barriers to meeting goals and should address any identified barriers. Both components must be listed in the medical record in order to select “Yes” in the Record Review Workbook. If the practice assesses potential barriers and none are identified, the practice may answer “Yes.”
Note: Practices must provide an example of how they meet each criterion and complete the Record Review Workbook. Examples are not required if a practice provides a report as evidence.

PCMH 2017

5.29.2018 QI 04A Are practices required to use the CAHPS PCMH survey to meet this requirement?

No. Practices may use any patient experience survey that includes questions related to three of the four categories specified in the standards (access; communication; coordination; whole-person care, self-management support and comprehensiveness).

PCMH 2017

5.29.2018 CC 01 What is the minimal information required to meet the requirements of the laboratory and radiology items outlined in CC 01?

There is no minimum data requirement. To meet this core requirement, practices must meet all six items outlined in CC 01. Practices must consider how best to demonstrate their process for each item to meet the intent as described in the guidance section of this criterion.

PCMH 2017

5.29.2018 QI 02B Are preventive care measures considered utilization measures?

No. Although effective preventive care can reduce future health care costs, preventive care measures address quality of care and are not utilization measures. Utilization measures address direct health care savings, in accordance with evidence-based guidelines.

PCMH 2017

5.29.2018 QI 04B May practices use the “comments” section in the patient experience survey to meet this requirement?

No. Comment sections or “free text” questions on a patient experience survey do not meet the requirement as a method of collecting qualitative feedback from patients and their families.

PCMH 2017

5.29.2018 QI 12 How do practices assess the effectiveness of improvement actions?

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.

PCMH 2017

5.29.2018 QI 12 When remeasuring to show improvement, what is an acceptable period of time between the initial measurement and the follow-up measurement period?

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.

PCMH 2017

5.29.2018 QI 11 May practices focus on improving the number of patient experience survey responses it receives back from patients?

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.

PCMH 2017

5.29.2018 QI 04A How many patients are practices required to survey?

NCQA does not prescribe a sample size or frequency of surveying; however, the survey must represent the entire patient population and not focus on specific conditions or patient groups

PCMH 2017

5.29.2018 QI 06 Are practices required to use an NCQA-Certified survey vendor to administer CAHPS PCMH?

No, practices are not required to use an NCQA-Certified survey vendor.

PCMH 2017

5.29.2018 QI 04 Can the practice choose to show reports from either quantitative data or qualitative data?

No. The practice needs to demonstrate that they collect both quantitative and qualitative data to meet the requirement.

PCMH 2017

5.29.2018 CC 10 (PP 04) Our practice has agreements with and shares patient records with behavioral healthcare providers, but we do not share the same EHR or physical location. Do we meet the requirement for integrating behavioral healthcare in our practice?

No. Although there is no requirement for a behavioral healthcare provider to be physically in the practice’s office, the behavioral healthcare provider must have at least partial access to the practice’s systems. Although the arrangements mentioned meet the intent of CC 09 (maintaining agreements with behavioral healthcare providers), they do not meet the requirements for this criterion.

If a practice site in an organization has integrated behavioral healthcare, the other sites in the organization may receive credit if there is also a process for their patients to access those behavioral healthcare services.

PCMH 2017