Transcript officepracticum.com

2015 User Conference
Patient Centered Medical Home (PCMH)
April 23, 2015
8:00am - 11:30am
Presented by:
Cindy Malek
Training Specialist
Room Monitor:
Pete Minio
Product Manager, Pediatric and Primary Care Solutions
Pre-Conference
Introduction
● 2014 Autocredits - 6.375 points
● New measures
● Improved functionality supporting PCMH:
○ Care Plans
○ Demographic Analysis and Recall
○ Additional CQMs
2015 Office Practicum User Conference
Where do I begin
2015 Office Practicum User Conference
Where do I begin
Is the practice Eligible?
● Order the Online Application
● Access the online application
○ Email confirmation sent with instructions on how to
access the online application
■ PCMH recognition is by site location - 3 or more
locations contact NCQA
■ All physicians seeing a patient panel at the location
will be included on the application
○ PCMH and HIPAA agreements signed
2015 Office Practicum User Conference
Where do I begin
● Submit the Application
○ Do not purchase the Survey Tool until you receive
approval and instruction
● Submit the Application Fee
● Submit the Survey Tool Fee (can be done at a later time)
● Prepare the Practice
2015 Office Practicum User Conference
Organize and Prepare
● Read the Office Practicum Roadmap
● Obtain the letter of Autocredit from Office
Practicum
● NCQA
○ Read the Standards and Guidelines
○ Attend the free Training Webinars
2015 Office Practicum User Conference
Organize and Prepare
●
●
●
●
●
●
Form a PCMH Team
Use the Standards Workbook as a checklist
Focus on the “must pass” elements and factors
Practice policy written
Practice procedure written
Organize your documents
2015 Office Practicum User Conference
Organize and Prepare
PCMH
Standards
Elements
Factors
2015 Office Practicum User Conference
Focus of Presentation
● Reports available in Office Practicum through the QIC
● Must Pass Elements and Factors
2015 Office Practicum User Conference
Scoring
Must Pass Elements:
● Basic building blocks of PCMH
● Must have a score of 50% or
higher
All must pass elements are required
for recognition. (6 total)
Level of Qualifying
Points
Must Pass Elements
Level 3
85-100
6 of 6
Level 2
60-84
6 of 6
Level 1
35-59
6 of 6
Not Recognized
0-34
<6
2015 Office Practicum User Conference
PCMH Standard 1:
Patient-Centered Access
Element
Must Pass
Element
# Factors
Critical
Factor
A: Patient Centered Appointment
Access
Yes
6
Factor 1
1A5
B: 24/7 Access to Clinical Advice
No
4
Factor 2
1B2, 1B3
C: Electronic Access
No
6
2015 Office Practicum User Conference
Report in OP
1C1, 1C2,
1C3, 1C4
PCMH Standard 1:
A: Patient-Centered Appointment Access
OPMH 1A1: Providing same-day appointments for routine and urgent care.
(CRITICAL FACTOR)
NCQA reviews a documented process
Scheduling same-day appointments that includes defining appointment types.
● Documented Policy written by the practice
● Define routine and urgent care
NCQA reviews a report
With at least five days of data, showing the availability and use of same-day
appointments for both urgent and routine care.
● Use of Slots on the Calendar window (screenshot)
● Scheduled appointments on the Calendar window (screenshot)
2015 Office Practicum User Conference
PCMH Standard 1:
2015 Office Practicum User Conference
PCMH Standard 1:
A: Patient-Centered Appointment Access
OPMH 1A5: Monitoring no-show rates
NCQA reviews a documented process
● Monitoring no-show rates.
NCQA reviews a report from a recent 30-calendar-day period
Denominator:
Scheduled appointments for the reporting period.
Numerator:
Appointments for the reporting period with a status of No
Show
2015 Office Practicum User Conference
PCMH Standard 1:
A: Patient-Centered Appointment Access
OPMH 1A5: Monitoring no-show rates
2015 Office Practicum User Conference
PCMH Standard 1:
A: Patient-Centered Appointment Access
OPMH 1A5: Monitoring no-show rates
2015 Office Practicum User Conference
PCMH Standard 1:
B: 24/7 Access to Clinical Advice
OPMH 1B2: Providing timely clinical advice by telephone. (CRITICAL
FACTOR)
*Note: This will include advice given before, during and after office hours
NCQA reviews a documented process
● Advice given by telephone whether the office is open or closed
● Define time frame for responses.
NCQA reviews a report from a recent 7-calendar-day period
Report using Message responses in Office Practicum
2015 Office Practicum User Conference
PCMH Standard 1:
B: 24/7 Access to Clinical Advice
OPMH 1B3: Providing timely clinical advice using a secure, interactive
electronic system.
*Note: This will include advice given before, during and after office hours
NCQA reviews a documented process
● Advice given whether the office is open or closed
● Define time frame for responses.
NCQA reviews a report from a recent 7-calendar-day period
Report using Message responses in Office Practicum
2015 Office Practicum User Conference
PCMH Standard 1:
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C1: More than 50 percent of patients have online access to their health
information within four business days of when the information is available to the
practice
Denominator:
Unique patient with a note charted during the reporting
period.
Numerator:
Contact for patient has created a patient portal account and
logged into the account
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C1: More than 50 percent of patients have online access to their health information within four
business days of when the information is available to the practice
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C2: More than 5 percent of patients view, and are provided the capability to
download, their health information or transmit their health information to a third party.
Denominator:
Unique patient with a note charted during the reporting period.
Numerator:
Contact has accessed the patient portal account and selected to
view, download or transmit information
2015 Office Practicum User Conference
PCMH Standard 1:
OPMH 1C2: More than 5 percent of patients view, and are provided the capability to download, their health
information or transmit their health information to a third party.
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C3: Clinical summaries are provided within 1 business day for more
than 50 percent of office visits
Denominator:
All notes charted during the reporting period.
Numerator:
Patients have a patient exit note that was generated either on paper
or electronically within one business days after the encounter date.
For this measure, “business days” is interpreted to exclude
weekends but not holidays.
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C4: A secure message was sent by more than 5 percent of patients
Denominator:
Unique patient seen during the reporting period
Numerator:
1 message originating from the Patient Portal addressed to a
provider or triaged and reply by the provider
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C5: Patients have two-way communication with the practice
2015 Office Practicum User Conference
PCMH Standard 1:
C: Electronic Access
OPMH 1C6: Patients can request appointments, prescription refills, referrals and test results.
2015 Office Practicum User Conference
PCMH Standard 2:
Team-Based Care
Element
Must Pass
Element
# Factors
A: Continuity
No
4
B: Medical Home Responsibilities
No
8
C: Culturally and Linguistically Appropriate
Services (CLAS)
No
4
D: The Practice Team
Yes
10
2015 Office Practicum User Conference
Critical
Factor
Report in OP
2A2
2C1, 2C2
Factor 3
PCMH Standard 2:
A: Continuity
OPMH 2A2: Monitoring the percentage of patient visits with selected clinician or
team
NCQA reviews a report from a recent 5-calendar-day period
● Percentage of patients seen by selected PCP
Denominator:
Patients with PCP selected in Patient Register
Numerator:
Encounters where rendering provider matches PCP in Patient
Register
2015 Office Practicum User Conference
PCMH Standard 2:
Step 1
2015 Office Practicum User Conference
Step 2
PCMH Standard 2:
2015 Office Practicum User Conference
PCMH Standard 2:
C: Culturally and Linguistically Appropriate Services
OPMH 2C1: Assessing the diversity of its population
2015 Office Practicum User Conference
PCMH Standard 2:
C: Culturally and Linguistically Appropriate Services
OPMH 2C2: Assessing the language needs of its population
2015 Office Practicum User Conference
PCMH Standard 2:
D: The Practice Team
● All Factors of Element D will need a policy/procedure written.
● Additional documents will be required to pass this Element.
OPMH 2D3: Holding scheduled patient care team meetings or a structured
communication process focused on individual patient care (CRITICAL FACTOR)
NCQA reviews
● Written process for structured communication between the practice team
● At least 3 samples of team meetings
○ communication samples (messages)
○ Samples as evidence the practice follow its written process
2015 Office Practicum User Conference
PCMH Standard 2:
D: The Practice Team
OPMH 2D3: Holding scheduled patient care team meetings or a structured
communication process focused on individual patient care (CRITICAL FACTOR)
WRITTEN POLICY/PROCEDURE
2015 Office Practicum User Conference
PCMH Standard 2:
D: The Practice Team
OPMH 2D3: Holding scheduled patient care team meetings or a structured
communication process focused on individual patient care (CRITICAL FACTOR)
SUPPORTING DOCUMENTATION
2015 Office Practicum User Conference
PCMH Standard 1:
Let’s
Try It
PCMH Standards
PCMH Standards
Standards Hands-on
2015 Office Practicum User Conference
PCMH Standard 3:
Population Health Management
Element
Must Pass
Element
# Factors
A: Patient Information
No
14
3A1 - 3A11,
3A13
B: Clinical Data
No
11
3B1 - 3B11
C: Comprehensive Health Assessment
No
10
D: Use Data for Population
Management
Yes
5
E: Implement Evidence-based Decision
Support
No
6
2015 Office Practicum User Conference
Critical
Factor
Factor 1
Report in OP
PCMH Standard 3:
A. Patient Information
●
●
●
●
●
●
●
OPMH 3A1: Date of birth populated for
more than 50 percent of patients
OPMH 3A2: Gender populated for
more than 50 percent of patients
OPMH 3A3: Race populated for more
than 50 percent of patients
OPMH 3A4: Ethnicity populated for
more than 50 percent of patients
OPMH 3A5: Language populated for
more than 50 percent of patients
OPMH 3A6: Telephone numbers
populated for more than 50 percent of
patients
OPMH 3A7: E-mail address populated
for more than 50 percent of patients
2015 Office Practicum User Conference
PCMH Standard 3:
A. Patient Information
OPMH 3A9: Dates of previous visits for more than 50 percent of patients
Denominator:
Unique patient seen during the reporting period
Numerator:
1 sick or well visit encounter note
2015 Office Practicum User Conference
PCMH Standard 3:
A. Patient Information
3A10
OPMH 3A10: Legal guardian
populated for more than 50
percent of patients
*Note: Role/Reason must be
entered as Mother, Father or
Legal Guardian
OPMH 3A11: Primary
Caregiver populated for more
than 50 percent of patients
2015 Office Practicum User Conference
3A11
PCMH Standard 3:
A. Patient Information
OPMH 3A13: Health Insurance
information
Report data pulled from
Subscriber ID field
*Note: this is a required field In
Office Practicum
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B1: An up-to-date problem list with current and active diagnoses for more
than 80 percent of patients
Denominator:
Unique patient seen during the reporting period
Numerator:
Problem list entry as Active/Tracking or No Active Problems
indicator set
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B3: Blood pressure, with the date of update, for more than 80 percent of
patients 3 years and older
Denominator:
Unique patient seen during the reporting period 3 or older
Numerator:
Blood Pressure taken during the reporting period
OPMH 3B4: Height/length for more than 80 percent of patients
Denominator:
Unique patient seen during the reporting period (all ages)
Numerator:
Height/length recorded
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B2: Allergies, including medication allergies and adverse reactions for
more than 80 percent of patients
Denominator:
Unique patient seen during the reporting period
Numerator:
Active/Tracking Allergy entry made including Problem entry. If
medication allergy must contain a NDC#. The indicator is set if
no medication allergies
Allergy Headings that will meet the Numerator: Medication Allergy, Rx Adverse
Reaction, Vaccine Reactions, Allergies, Allergies/Reactions
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B5: Weight for more than 80 percent of patients
Denominator:
Unique patient seen during the reporting period (all ages)
Numerator:
Weight recorded
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B6: System calculates and displays BMI
Denominator:
Unique patient seen during the reporting
Numerator:
BMI Calculated
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B7: System plots
and displays growth charts
(length, weight, head
circumference (0-2)/BMI
percent (0-20)
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B8: Status of tobacco use for patients 13 years and older for more than 80
percent of patients
Denominator:
Unique patient with a note charted during the reporting period.
Numerator:
Smoking status complete in the Risk Assessment
The smoking status may have been taken either during or prior to the reporting
period. The above measure does not have to be updated at every patient
encounter.
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B9: List of prescription medications with date of updates for more than
80 percent of patients
Denominator:
Total medications written during the reporting period
Numerator:
Medications written with a Purpose of "Med - to dispense"•or "Med office sample" or "Med - office administered
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B10: More than 20 percent of patients have family history recorded as
structured data
Denominator:
Unique patient seen during the reporting period
Numerator:
Family history recorded in the new Family History tab
2015 Office Practicum User Conference
PCMH Standard 3:
B. Clinical Data
OPMH 3B11: At least 1 electronic progress note created, edited and signed by an
eligible professional for more than 30 percent of patients with at least one office
visit
Denominator:
Total scheduled patient appointments during the reporting
period
Numerator:
Finalized patient exit note
2015 Office Practicum User Conference
PCMH Standard 3:
D. Use Data for Population Management
Factor 1: At least two different preventive care services.
Factor 2: At least two different immunizations
Factor 3: At least three different chronic or acute care services.
Factor 4: Patients not recently seen by the practice.
Factor 5: Medication monitoring
Factors 1–3 blend two Meaningful Use criteria in each factor:
Generate lists of patients: At least one list of patients with a specific condition to
use for quality improvement, reduction of disparities and outreach.
Send reminders: Send an appropriate reminder for preventive or follow-up care
to more than 20 percent of all patients 65 years or older or 5 years or younger.
2015 Office Practicum User Conference
PCMH Standard 3:
D. Use Data for Population Management
NCQA reviews materials showing how patients were notified for each service (e.g.,
call logs with successful contact vs. unsuccessful contact, examples of blinded
letters sent to patients, a script or description of phone reminders, screen shots of
electronic notices).
2015 Office Practicum User Conference
PCMH Standard 3:
E. Implement Evidence-Based Decision
Support
● Decide who will enroll patients in care plans (auto,
clinical staff, or providers)
● Make all staff aware of plans and triggers so that the
office will meet them
● Review care plans delivered with OP14; Activate and
update if necessary
2015 Office Practicum User Conference
PCMH Standard 3:
Let’s
Try It
PCMH Standards
PCMH Standard 4:
Care Management and Support
Element
Must Pass
Element
# Factors
Critical
Factor
A: Identify Patients for Care Management
No
6
Factor 6
4A6
B: Care Planning and Self-Care Support
Yes
5
C: Medication Management
No
6
Factor 1
4C1 - 4C6
D: Use Electronic Prescribing
No
4
4D1, 4D2
E: Support Self-Care and Shared Decision
Making
No
7
4E1
2015 Office Practicum User Conference
Report in OP
PCMH Standard 4:
A. Identify Patients for Care Management
OPMH 4A6: The practice monitors the percentage of the total patient
population identified through its process and criteria (CRITICAL FACTOR)
Denominator:
Total active patients
Numerator:
Care Coordinator entered in the Coord Care tab -ORAn active problem list entry for "under care of case manager"
(SNOMED=416933006) OR "under care of team"
(SNOMED=401322007)
Factor 6: Assessment of a combination of factors 1–5 results in a subset of the practice’s entire panel
of patients identified as likely to benefit from care management.
Note: Patients identified in this element will be used to draw a sample for the medical record review
required in PCMH 4, Elements B and C.
2015 Office Practicum User Conference
PCMH Standard 4:
A. Identify Patients for Care Management
2015 Office Practicum User Conference
PCMH Standard 4:
B. Care Planning and Self-Care Support
(Must Pass)
The care team and patient/family/caregiver collaborate (at relevant visits) to
develop and update an individual care plan, using the Factors of Element B, for at
least 75 percent of the patients identified in Element A
Factors:
1. Incorporates patient preferences and functional/lifestyle goals
2. Identifies treatment goals
3. Assesses and addresses potential barriers to meeting goals
4. Includes a self-management plan
5. Is provided in writing to the patient/family/caregiver
2015 Office Practicum User Conference
PCMH Standard 4:
B. Care Planning and Self-Care Support
(Must Pass)
Documentation
Factors 1–5: NCQA reviews reports from the practice’s electronic system, OR the Record Review
Workbook. If using the Record Review Workbook examples are required demonstrating how each
factor is documented.
The practice calculates a percentage that requires a numerator and a denominator using one of
the following methods.
Method 1: Query the practice’s electronic registry, practice management system or other
electronic systems for the patients identified in Element A. This method is used if the practice can
determine a denominator, as described below.
Denominator = Total number of patients identified through the criteria in Element A seen at least
once for a relevant visit by the practice in a recent three-month period.
Numerator = Number of patients identified in the denominator for whom each item is entered in the
medical record.
Method 2: Use the instructions in the Record Review Workbook to choose a sample of relevant
patients and check for the relevant items. For each factor to which the practice responds "yes," it
provides an example of how it meets the factor.
2015 Office Practicum User Conference
PCMH Standard 4:
B. Care Planning and Self-Care Support
(Must Pass)
Let’s identify ways to meet this Element
● Use phrases
○ Counseling
○ Plan
● Modify Review of Systems
● Surveys
● Use Alternate Notes to create and print Care Plan
2015 Office Practicum User Conference
PCMH Standard 4:
C. Medication Management
OPMH 4C1: Reviews and reconciles medications for more than 50 percent of
patients received from care transitions
OPMH 4C2: Reviews and reconciles medications for more than 80 percent of
patients received from care transitions
Denominator:
All inbound referral responses created during the reporting
period OR new patients with an encounter that is not a well visit
(CPT claim coded as between 99200 and 99209 which
indicates a NEW patient encounter).
Numerator:
Performance is met where inbound transitions of care have
med reconciliation status marked as Performed or Not Required
2015 Office Practicum User Conference
PCMH Standard 4:
C. Medication Management
OPMH 4C3: Provides information about new prescriptions to more than 80
percent of patients/families/caregivers
Denominator:
Unique patient with a note charted during the reporting period.
Numerator:
Contact for patient has created a patient portal account and
logged into the account
2015 Office Practicum User Conference
PCMH Standard 4:
C. Medication Management
OPMH 4C4: Assesses understanding of medications for more than 50
percent of patients/families/caregivers, and dates the assessment
OPMH 4C5: Assesses response to medications and barriers to adherence for
more than 50 percent of patients, and dates the assessment
OPMH 4C6: Documents over-the-counter medications, herbal therapies and
supplements for more than 50 percent of patients, and dates updates
Denominator:
Unique patient with a note charted during the reporting period.
Numerator:
Medication list marked as reviewed within the reporting period
2015 Office Practicum User Conference
PCMH Standard 4:
C. Medication Management
Methods of marking the medication list reviewed
Patient Chart
Medications Tab from the
Chart
2015 Office Practicum User Conference
PCMH Standard 4:
C. Medication Management
Methods of marking the medication list reviewed
Med Review tab when charting a visit
2015 Office Practicum User Conference
PCMH Standard 4:
D. Use Electronic Prescribing
OPMH 4D1: More than 50 percent of eligible prescriptions written by the practice
are compared to drug formularies and electronically sent to pharmacies
Denominator:
All inbound referral responses created during the reporting
period OR new patients with an encounter that is not a well visit
(CPT claim coded as between 99200 and 99209 which
indicates a NEW patient encounter).
Numerator:
Performance is met where inbound transitions of care have
med reconciliation status marked as Performed or Not Required
2015 Office Practicum User Conference
PCMH Standard 4:
D. Use Electronic Prescribing
OPMH 4D1: More than 50 percent of eligible prescriptions written by the practice
are compared to drug formularies and electronically sent to pharmacies
Denominator:
Total permissible medications written during the reporting
period
Numerator:
All permissible medications that include an eRx-ID and queried
for a drug formulary
2015 Office Practicum User Conference
PCMH Standard 4:
D. Use Electronic Prescribing
OPMH 4D2: Enters electronic medication orders in the medical record for more
than 60 percent of medications
Denominator:
Total medications written during the reporting period
Numerator:
Medications written with a Purpose of "Med - to dispense"•or "Med office sample" or "Med - office administered
2015 Office Practicum User Conference
PCMH Standard 4:
D. Use Electronic Prescribing
OPMH 4D3: Performs
patient-specific checks for
drug-drug and drug-allergy
interactions
OPMH 4D4: Alert prescribers
to generic alternatives
2015 Office Practicum User Conference
PCMH Standard 4:
D. Use Electronic Prescribing
OPMH 4D3: Performs patient-specific checks for drug-drug and drug-allergy
interactions
OPMH 4D4: Alert prescribers to generic alternatives
Screenshots documenting this capability
2015 Office Practicum User Conference
PCMH Standard 4:
E. Support Self-Care and Shared Decision
Making
OPMH 4E1: Uses and EHR to identify patient-specific education resources and
provide them to more than 10 percent of patients
Denominator:
Unique patient with a note charted during the reporting period.
Numerator:
“Patient education given” checkbox was checked. (This happens
automatically when Resources are ordered.)
If you manually check the Patient Education checkbox, you will need to include a free-text note in the visit
indicating what material was given.
2015 Office Practicum User Conference
PCMH Standard 4:
Let’s
Try It
PCMH Standards
PCMH Standard 5:
Care Coordination and Care Transitions
Element
Must Pass
Element
# Factors
Critical
Factor
A: Test Tracking and Follow up
No
10
Factor 1,
Factor 2
5A6 - 5A10
B: Referral Tracking and Follow up
Yes
10
Factor 8
5B7
C: Coordinate Care Transitions
No
7
2015 Office Practicum User Conference
Report in OP
5C7
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A6: Follows up with the inpatient facility about newborn hearing and
newborn blood-spot screening
Denominator:
Active patients less than 1 year of age
Numerator:
Hearing Screen entry on the Birth Info tab and Newborn Screen
marked on the Newborn History tab
2015 Office Practicum User Conference
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A6: Follows
up with the inpatient
facility about newborn
hearing and newborn
blood-spot screening
2015 Office Practicum User Conference
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A7: More than 30 percent of laboratory orders are electronically
recorded in the patient record
Denominator:
Total Lab requisitions written during the reporting period
Numerator:
Labs with a result date
OPMH 5A8: More than 30 percent of radiology orders are electronically recorded
in the patient chart
Denominator:
Total Radiology Lab requisitions written during the reporting
period
Numerator:
Radiology labs with a result date
2015 Office Practicum User Conference
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A7: More than 30 percent of laboratory orders are
electronically recorded in the patient record
OPMH 5A8: More than 30 percent of radiology orders are electronically recorded
in the patient chart
2015 Office Practicum User Conference
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A9: Electronically incorporates more than 55 percent of all clinical
lab test results into structured fields in medical record
Denominator:
All labs ordered during the reporting period. (See exclusions)
Numerator:
Performance is met for those with at least one result row with the
result expressed in positive/negative or numeric format.
Excludes labs in the Procedure or Screen categories. Also excludes Legacy labs.
Lab interface will make this measure easier to achieve.
2015 Office Practicum User Conference
PCMH Standard 5:
A. Test Tracking and Follow-Up
OPMH 5A10: More than 10 percent of scans and tests that result in an image are
accessible electronically
Denominator:
Total Radiology Lab requisitions written during the reporting
period with a result
Numerator:
Scan attached to the radiology lab requisition.
2015 Office Practicum User Conference
PCMH Standard 5:
B. Referral Tracking and Follow-Up
OPMH 5B7: Has the capacity for electronic exchange of key clinical information
and provides an electronic summary of care record to another provider for more
than 50 percent of referrals
Denominator:
All referrals written to a specialist during the reporting period
Numerator:
Summary of Care selected for the referral
Summary-of-care record does not need to be electronic itself to meet this factor, it
just needs to be produced electronically.
2015 Office Practicum User Conference
PCMH Standard 5:
Screenshot of referral and
print available of all
associated reports
2015 Office Practicum User Conference
PCMH Standard 5:
Optional: Send electronically
Direct Messaging
● Edit Address Book
Entries
● Are you going to
Publish for the
Patient Portal
o Will permit
parents to send
records
2015 Office Practicum User Conference
PCMH Standard 5:
C. Coordinate Care Transitions
OPMH 5C7: Exchange key clinical information with facilities and provides an
electronic summary-of-care record to another care facility for more than 50 percent
of patient transitions of care
Same calculation as 5B7
Denominator:
All referrals written to a specialist during the reporting period
Numerator:
Summary of Care selected for the referral
2015 Office Practicum User Conference
PCMH Standard 5:
Let’s
Try It
Standards Hands-on
2015 Office Practicum User Conference
PCMH Standard 6:
Performance Measurement and Quality
Improvement
Element
Must Pass
Element
# Factors
A: Measure Clinical Quality Performance
No
4
B: Measure Resource Use and Care
Coordination
No
2
C: Measure Patient/Family Experience
No
4
D. Implement Continuous Quality
Improvement
Yes
7
E. Demonstrate Continuous Quality
Improvement
No
4
F. Report Performance
No
4
G. Use Certified EHR Technology (No
Scoring)
No
10
2015 Office Practicum User Conference
Critical
Factor
Report in OP
PCMH Standard 6:
Performance Measurement and Quality
Improvement
When a practice selects measures of performance, the
practice documents the following for each measure:
● period of measurement
● number of patients represented by the data
● rate (percent) based on a numerator and denominator
2015 Office Practicum User Conference
PCMH Standard 6:
A. Measure Clinical Quality Improvement
OPMH 6A1: At least 2
immunization measures
OPMH 6A2: At least 2 other
preventive care measures
OPMH 6A3: At least 3
chronic or acute care clinical
measures
2015 Office Practicum User Conference
PCMH Standard 6:
A. Measure Clinical Quality Improvement
What else can I use?
2015 Office Practicum User Conference
PCMH Standard 6:
What else can I use?
2015 Office Practicum User Conference
PCMH Standard 6:
What else can I use?
2015 Office Practicum User Conference
PCMH Standard 6:
D. Implement Continuous Quality Improvement
(Must Pass)
NCQA has Quality Measure/Improvement worksheets or can submit practice
report of how measures were queried, reported to appropriate office staff, Quality
Improvement project was initiated, and then report back to group for follow up.
Screenshots of queries with associated documented Quality Improvement
projects and meeting minutes are appropriate.
2015 Office Practicum User Conference
PCMH Standard 6:
D. Implement Continuous Quality Improvement
(Must Pass)
For the practice to reach a desired level of
achievement based on its self-identified
standard of care
● Review and evaluate
performance against
goals
● Address Barriers
2015 Office Practicum User Conference
Quality Improvement
Element A (3 measures)
Element B (1 measure)
Element C (1 measure)
PCMH Standard 6:
E. Demonstrate Continuous Quality
Improvement
Quality improvement is a continual process that is built into the practice’s daily
operations and requires an ongoing effort of assessing, improving and
reassessing. This element emphasizes ongoing quality improvement through
comparison of performance results to demonstrate that the practice has gone
beyond setting goals and taking action.
Will continue with the measures identified in Element D.
Effectiveness:
● Completed Quality Measurement and Improvement Worksheet
Achievement of improved performance:
● Submit sequential screenshots of queries that show actual improvement in
quality of care and reports/meeting minutes that accompany those queries as
part of practice Quality Improvement process
2015 Office Practicum User Conference
PCMH Standard 6:
G. Use Certified EHR Technology
This element is for data collection purposes only and will not be
scored.
● Factors 1, 8 and 9 require comments in the Support
Text/Notes box of the Survey Tool.
● Factors 4, 5, and 7 require comments in the Support
Text/Notes box of the Survey Tool if NA is selected.
2015 Office Practicum User Conference
PCMH Standard 6:
G. Use Certified EHR Technology
OPMH 6G1: The practice uses EHR
system that has been certified and issued
a CMS certification ID
2015 Office Practicum User Conference
PCMH Standard 6:
G. Use Certified EHR Technology
OPMH 6G2: The practice conducts a security risk analysis of its EHR system,
implements security updates as necessary and corrects identified security
deficiencies.
Cyber Security
OP Cloud Privacy and Security Safeguards
2015 Office Practicum User Conference
PCMH Standard 6:
G. Use Certified EHR Technology
OPMH 6G10: The practice generates lists of patients, and based on their preferred
method of communication, proactively reminds more than 10 percent of
patients/families/caregivers about needed preventive/follow-up care.
2015 Office Practicum User Conference
●
●
●
●
●
●
Form a PCMH Team
Use the Standards Workbook as a checklist
Focus on the “must pass” elements and factors
Practice policy written
Practice procedure written
Organize your documents
2015 Office Practicum User Conference
Links to Remember
NCQA General Information:
http://www.ncqa.org/Home/PatientCenteredMedicalHome.aspx
Standards:
http://store.ncqa.org/index.php/recognition/2014-pcmh-standards-and-guidelinesepub-single-user.html
Purchase Survey Tool ($80)
http://store.ncqa.org/index.php/recognition/2014-pcmh-survey-tool-web-based.html
2015 Office Practicum User Conference
2015 Office Practicum User Conference
We want your feedback!
2015 Office Practicum User Conference