As part of the Patient-Centered Specialty Practice (PCSP) and Oncology Medical Home Recognition re-design process, NCQA made updates to the structure, process and program requirements.
What’s Changed? – Requirements Structure
NCQA’s PCSP and Oncology Medical Home Recognition programs have evolved to feature a set of seven concepts that are vital to strong specialty care. Underlying these concepts are criteria (activities for which a practice must demonstrate adequate performance to obtain NCQA PCSP Recognition) developed from evidence-based guidelines and best practices.
The Standards and Guidelines document contains these Recognition program requirements and information your practice needs to demonstrate to NCQA that you meet criteria. Refer to the concepts and criteria within this document, available for free download from the NCQA store. In this publication, you will find the criteria and what evidence is needed to submit to NCQA to earn recognition.
- Concepts. There are seven concepts—the overarching themes of patient-centered care. To earn recognition, your practice must complete criteria in each concept area. If you are familiar with past iterations of NCQA PCSP Recognition, the concepts are equivalent to standards.
- Criteria. Specific activities in which a practice engages to demonstrate that it meets recognition requirements.
- Competencies. Competencies categorize the criteria. Competencies do not offer credit.
What’s Changed? – Scoring
With this new process and new standards also comes a new way of thinking about scoring. To simplify the scoring process, there are now “Core” criteria and “Elective” criteria.
To earn recognition a practice must meet all the core criteria and a certain number of elective credits across any of the 7 concepts.
- PCSP: 38 Core; 20 Elective Credits.
- Oncology: 49 Core; 9 Elective Credits.
Most elective criteria are worth one credit, but some are worth two or three credits. You can piece together elective credits any way you want.
Once your practice meets the core and elective criteria, it will achieve NCQA Recognition.
What’s Changed? – Requirements
NCQA changed or modified some criteria to better align with PCMH and that helps practices:
- Better meet the needs of patients.
- Implement ongoing quality improvement.
- Better manage referrals and follow-up.
- Leverage evidence-based tools, resources and guidelines to provide patient care.
- Emphasize the importance of communication and coordination with hospitals and other care providers.
- Measure and understand disparities in care.
Want to see what’s changed? You can download a crosswalk from PCSP 2016 to the new requirements.
What’s Changed? – Process & Timing
Previously you waited until you transformed your practice and submitted evidence to NCQA all at once. Now, you begin transforming your practice and enroll in recognition through Q-PASS. Once you enroll:
- You will be assigned an NCQA Representative who will walk you through the recognition process and work with you to plan dates for your virtual reviews.
- Participate in up to 3 virtual reviews. Demonstrate that you are embracing the transformation process and quality improvement via virtual reviews.
- After earning recognition, each year your practice performs ongoing quality improvement and submits evidence of this during Annual Reporting to sustain recognition and succeed as a NCQA PCSP recognized practice.
If you are seeking renewal, the new process will save you time.
- Practices that have earned PCSP Level 1 and Level 2 recognition can renew at an accelerated pace by attesting to certain criteria. The Accelerated Renewal table identifies which criteria you can attest to and which you must submit documentation for. The Accelerated Renewal Table is available in the Resources folder of the PCSP publication download.
- Practices that have earned PCSP Level 3 recognition can renew through the Annual Reporting process, saving you time. You will attest to continuing to meet criteria and submit data and some documentation. This process is not as involved as initial recognition, but it maintains a practice’s recognition and encourages continuous improvement. Coming soon.
Below are recommended time frames for enrollment. If you are:
- Not currently recognized: Enroll in recognition through Q-PASS 9-12 months prior to your desired recognition date. See suggested timeline.
- Recognized as a PCSP Level 1 or 2: Enroll in recognition through Q-PASS 6-12 months prior to your expiration date. See suggested timeline.
- Recognized as a PCSP Level 3: Enroll in Annual Reporting 3-4 months prior to your expiration date. See suggested timeline.
What’s Changed? – Recognizable Entity
Previously NCQA recognized organizations at the practice site level. However, NCQA found there are many organizations with multi-specialty practices that want to bring groups of specialties through at a time, but not a whole practice site.
As a result, NCQA is adjusting what a recognizable entity is. Recognition will be earned at the specialty level at each practice site. If a practice includes more than one specialty, each specialty within that practice site seeking recognition must complete an evaluation to earn recognition, as they will be recognized as different entities. Similarly, if a specialty group practices at multiple sites, each specialty at each site would earn a recognition.
- Example – Recognitions at a single site: If a practice site has cardiologists, rheumatologists and endocrinologists at the same site and all wanted to earn recognition, three different PCSP Recognitions would be earned – one for the cardiologists, one for the rheumatologists and one for the endocrinologists. If only the cardiologists wanted to earn recognition, they could do so for the cardiology specialty without earning recognition for the whole practice site.
- Example – Recognitions at multiple sites: An OB/GYN group has five sites. To earn recognition across all five sites, the organization would seek recognition for the specialty level at each site for a total of five Recognitions.
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