Transcript Many Paths to PCMH

HRSA’s Quality Initiatives – Many
Paths to a Patient Centered
Medical Home
May 31, 2012
Alyson Roby - AAAHC
Lon Berkeley – The Joint Commission
William Tulloch – National Committee for Quality Assurance
Harriet McCombs – HRSA/BPHC/OQD
Nina Brown - HRSA/BPHC/OQD
1
Learning Objectives
1. Identify the difference between the Accreditation and the
PCMHH Initiatives;
2. Identify the difference between the Patient Centered
Medical Home recognition conducted by the three
recognizing organizations;
3. Identify resources on the HRSA webpage that are
available to help grantees select the recognition
organization that best meets their health center needs; and
4. Understand the process for enrolling in the initiative and
the timelines involved with medical home recognition.
2
Session Outline
• Introduction – 5 minutes
• Purpose of PCMH Recognition – 10 minutes
• Contractor Presentations – 45 minutes
• Summary – 5 minutes
• Question & Answer – 25 minutes
3
The Patient Centered
Medical Home
• An approach to providing comprehensive, patient centered,
and coordinated primary care for health center patients.
• HHS Priority Recognition Goal
– Goal: 25% of grantees recognized by 9/30/2013
– Goal: 13% of grantees recognized by 12/31/2012
• HRSA investments in quality
– Patient-Centered Medical Health Home Initiative
o Covers survey costs and fees
– Accreditation Initiative
o Covers survey costs and fees
– PCMH Supplemental funds
– Partnership with the CMS Primary Care Demonstration
4
Why PCMH?
• Demonstrates the quality of care provided in health
centers.
• Positions health centers at an advantage for the changing
health care landscape.
• Transforms patient care to help health centers achieve
the three part aim of: Better Care, Healthy People and
Communities, and Affordable Care.
5
Many Paths to PCMH
• Many entities across the country are embracing the PCMH
model:
– Private Payers: Blue Cross Blue Shield, United Health
Care, etc.
– States: Oregon & Minnesota
o Initiatives the provide TA and lead to 3rd party
recognizing organization, i.e. NCQA, AAAHC, TJC
• HRSA supports 2 initiatives to assist grantees with the
survey costs and assistance in achieving PCMH
recognition.
– The Accreditation Initiative: Accreditation Association
for Ambulatory Health Care (AAAHC) & The Joint
Commission
– The Patient Centered Medical Health Home Initiative:
NCQA
6
Agenda
• Brief History of Organization
• Organization Surveyors
• The Handbook of Standards
• Education Opportunities & Pre-Survey Activities
• Overview of the Survey
• Certification/ Recognition
• Post-Survey Activities and Resources
• Organization Contacts
7
Contractor Presentations
1. Alyson Roby – Accreditation Association for Ambulatory
Health Care
2. Lon Berkeley – The Joint Commission
3. William Tulloch – National Committee for Quality
Assurance (NCQA)
8
Accreditation Association for
Ambulatory Health Care (AAAHC)
Accreditation Initiative
Alyson Roby, MD
AAAHC Surveyor
Family Practice Physician
9
AAAHC Mission
AAAHC is committed to maintaining its
position as the preeminent leader in
developing standards to advance and
promote patient safety, quality, value
and measurement of performance for
ambulatory health care through peer
based accreditation processes,
education, and research.
10
Brief History of the AAAHC
• AAAHC has been conducting surveys since 1979.
• Not-for-profit and governed by 18 member organizations.
• AAAHC is recognized by many third-party payors including
Medicare, Medicare Advantage plans, HRSA, Indian Health
Services, and Department of Energy.
• In 1983, AAAHC began accrediting managed care
organizations.
• CMS granted AAAHC deemed status for Medicare
certification for ambulatory surgery centers.
• AAAHC currently accredits more than 5,100 organizations,
and is the largest accreditor of ambulatory settings.
11
Who We Accredit
• Community health centers (Internal Medicine, Family
Practice, and Pediatrics)
– Medical Home
– Women’s health
– Laboratory and x-ray facilities
– Behavioral health
– Dental
• School-based health centers
• Walk-in clinics
• Indian Health Centers
12
Why choose AAAHC?
• Emphasis on education and consultation to organizations
• Not “inspectors”
• Peer-based accreditation program
• Nationally-recognized standards
• 325 surveyors (physicians, dentists, Advanced Practice
Registered Nurses and other nurses, pharmacists, health
care administrators, etc.)
• CHC-specific surveyors who will perform your surveys are
selected, trained, and privileged to conduct FQHC surveys
13
How are AAAHC Standards
Assessed?
• Substantial Compliance (SC) – Current operations are
acceptable and meet the Standards
• Partial Compliance (PC) – A portion of the standard is met
in an acceptable manner, but area(s) need to be addressed
• Non-Compliance (NC) – Current operations do not meet the
Standard
• Not Applicable (NA) – This Standard does not apply to this
organization
14
Handbook of Standards:
Core Chapters
• Chapter 1 – Rights of Patients
• Chapter 2 – Governance
• Chapter 3 – Administration
• Chapter 4 – Quality of Care Provided
• Chapter 5 – Quality Management and Improvement
• Chapter 6 – Clinical Records and Health Information
• Chapter 7 – Infection Prevention and Control and Safety
• Chapter 8 – Facilities and Environment
15
Handbook of Standards:
Adjunct Chapters
• Medical Home
• Pharmaceutical Services
• Pathology and Medical Laboratory Services
• Diagnostic and Other Imaging Services
• Dental Services
• Health Education and Health Promotion
• Behavioral Health Services
• Teaching and Publication Activities
• Immediate/Urgent Care Services
16
Medical Home
• Transformation to a Medical Home is a journey worthy of the investment
of time and resources.
– Stronger relationships = higher treatment plan compliance
– Fewer hospital days, fewer ER visits
– Higher satisfaction levels for patient, providers, staff
• Foundation of the Medical Home model of care focuses on:
– Patient and provider relationship
– Continuity of care
– Comprehensiveness of care
– Accessibility
– Quality
17
Educational Opportunities/
Pre-Survey Activities
• Technical Assistance
• Mock Surveys
• Pre-Survey Calls with Surveyors
• Achieving Accreditation
• Dedicated Staff Availability
18
Pre-Survey Activities:
Application Process
• Select AAAHC on your NOI (Notice of Interest) and submit
it to [email protected]
• Once the NOI is approved, AAAHC will be notified and they
will send you a welcoming letter containing instructions on
the online application for the survey.
• Application Supporting Documents:
• Brief organization history and current org chart
• Statement of Patient Rights and Responsibilities
• Governing Body meeting minutes
• Patient satisfaction survey results
• Quality improvement plan and studies
• Emergency preparedness plan
19
Overview: Day of the Survey
• Opening conference with senior leaders and Board
members
• Tour of facility and introduction to staff
• Review of select clinical records, policies, and other
documentation to support compliance
• Review and discussion of QI plan and studies
• Interaction with staff and patients
• Summation conference, including consultative advice for
improving quality of care and safety for patients, staff and
others
20
Recognition
• Public recognition of National recognized accreditation
• Consultative guidance
• Quality improvement
• Increase consumer awareness
21
Post-Survey Activities
and Resources
• FQHCs are eligible to sign-up for participation in one
complimentary six-month QI study with the Institute for
Quality Improvement (IQI)
• Information on www.aaahc.org/institute
• Primary care/non-surgical studies are designed to examine
processes and outcomes at the point of care
• A “QI Toolkit” of educational publications provides:
– A step-by-step Workbook
– Examples of award-winning studies
– Basic information and examples of important QI topics
– IQI staff available to assist and answer QI questions
22
Questions about
Survey Preparation
• Commonly-asked questions:
– Estimated length of time to prepare for survey
– Common areas for improvement
– Estimated length of time to complete survey
– How long will it take to get the survey report
23
Keep in Mind
AAAHC is about:
Discovery………………vs. inspection
Consultation…………vs. prescription
Collaborative……..……vs. dictatorial
24
In Conclusion
• Focus - Quality of care at the provider/patient level
• Goal - Improve and enhance health care in ambulatory
settings
• Standards - Designed to promote excellence,
professionalism and patient safety
• Survey Process - Assure compliance with published
standards through education and consultation
25
Visit us: www.aaahc.org
26
AAAHC Contacts
• Michon Villanueva
• [email protected]
• (847) 853-6063
• Gina Stepuncik Prus, MHA
• [email protected]
• (847) 324-7700
27
The Joint Commission’s
Accreditation &
Primary Care Medical Home (PCMH)
Certification Option
Lon M. Berkeley
Project Co-Lead, Primary Care Medical Home Initiative
Project Director, Community Health Center Accreditation
The Joint Commission
May 30 & 31, 2012
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Joint Commission
Background
• General customer base
– Accredits or certifies over 19,000 total organizations
(hospitals/critical access hospitals, labs, behavioral
health, home care/Durable Medical Equipment, long term
care, ambulatory care/office-based surgery)
• Accrediting Ambulatory Care since 1975:
– Ambulatory Care program accredits over 2,000
organizations with 6,400 sites of care
– Wide variety of ambulatory settings, including
Medical/Dental settings such as:
• Federally Qualified Health Centers (almost
300)
• Medical Group Practices
29
Primary Care Medical Home
Distinguishing Features
• Applies to an accredited ambulatory care organization
(or one seeking accreditation)
• On-site survey process to evaluate compliance with both
existing ambulatory care and PCMH requirements
• No special application requirements
• No additional on-site survey time
• No jeopardy to accreditation
• Organization-wide certification for up to 3 years
• Primary Care Medical Home certification publicly
available on Quality Check at
http://www.qualitycheck.org/
30
Joint Commission Accreditation
Plus
Primary Care Medical Home Option
PCMH Certification Option
(52 additional requirements)
Ambulatory Care Accreditation
(~ 900 applicable standards pertaining to
medical settings, including 123 applicable to PCMH)
Increasing
Patient-Centeredness,
Comprehensiveness,
Access, Coordination
31
The Joint Commission’s
PCMH Requirements*
5 Operational Characteristics
1.
2.
3.
4.
5.
Patient-Centeredness
Comprehensive Care
Coordinated Care
Superb Access to Care
System-Based Approach to Quality and
Safety
*from the Agency for Health Care Research and Quality
32
Accreditation + PCMH
On-Site Survey Process
• On-site survey: No change to ambulatory survey sessions
• Trace patient experience (patient tracers)
– Observe care provided
• Conduct patient interviews re:
– Selection of primary care clinician
– Information offered on how to access the center
– Consideration of language, cultural needs and preferences
• Discussions with organization leaders and staff re:
– Scope of services available- acute, chronic, behavioral health
– Determining the composition of interdisciplinary teams
• Observe use of infrastructure elements
– Clinical decision support tools, HIT, e-prescribing, referral tracking
33
Accreditation + PCMH
On-Site Survey Process
• Clinical Record review
– Patient self-management goals
– Follow-up on care recommendations, test results
• Building Tours
• HR file review
– Primary care clinician qualified for the role, working within scope of
practice, and in accordance with laws & regulation
• Review of performance improvement data
– Patient perception of access and care coordination
• Daily Briefings and Exit Conference
– Written report with both accreditation & PCMH requirements for
improvement
34
Accreditation + PCMH:
Post-Survey Process
• Follow-up to findings (“Requirements for Improvement”):
Evidence of Standards Compliance for both PCMH and
other ambulatory care standards
• Acceptance of Evidence of Standards Compliance:
– Special Certification Letter
– Posting on Quality Check
•
3 year Accreditation and Certification period
•
Periodical Performance Review
– Annual self-assessment of PCMH and ambulatory care standards
35
Joint Commission PCMH
Decision & Scoring Impacts
 Failure to comply with all PCMH “Requirement
for Improvements” will not jeopardize
accreditation status
 Scoring for PCMH requirements during a
resurvey is similar to expectations for an initial
survey, minimally:
– Implement in at least one location,
for at least one population
– Have supporting written policies/procedures
– Plan to implement organization-wide prior to next
triennial survey (18-36 months)
36
“Readiness” Steps
for PCMH Certification Option
If already accredited:
• Complete self-assessment relative to additional
PCMH Requirements
– Mock Tracers
– Technical assistance
• Determine best timetable for survey:
– Include as part of next triennial unannounced survey
– Special extension survey
– Communicate to Joint Commission (part of new
application)
37
“Readiness” Steps
for PCMH Certification Option
If not yet accredited:
• Complete self-assessment of ambulatory care accreditation
standards & additional PCMH Requirements
•
Use resources available:
– Mock Tracers
- Educational programs
– Technical assistance
- Publications
• Determine best timetable for survey
– Include as part of scheduled survey
– Communicate to Joint Commission (part of new application)
38
PCMH Certification Option
Preparation Time
• Estimated time if:
– Joint Commission accredited with existing Medical Home
recognition: 1 – 6 months
– Joint Commission accredited without existing Medical Home
recognition: 6 – 9 months
– Not yet Joint Commission accredited but have Medical Home
recognition: 6 - 12 months
– Not yet Joint Commission accredited and no Medical Home
recognition: 6 - 15 months
39
Accreditation + PCMH:
Application Process
• Application Process
– Part of web-based ‘extranet’ platform “e-application”
– First time survey: YOU designate ready date
– Already accredited options:
o Request as part of unannounced triennial survey
o Extension survey: 4-6 months after notification
o Earlier triennial survey
• To Access the Application:
– If you are currently accredited, contact:
Rex Zordan, 630.792.5509, [email protected]
– If you are NOT accredited, contact
Isa Rodriguez, 630.792.5286, [email protected]
40
Joint Commission
PCMH Resources
• Joint Commission Primary Care Medical Home Website
http://www.jointcommission.org/PCMH
– PCMH requirements
– Self-Assessment Tool
– Register for trial version of E-dition
(Free 60-day access to electronic
version of Ambulatory Care Standards)
– Request application
– News, articles and links to other
resources!
– Comparisons to other evaluative
models.
41
Joint Commission Accreditation
+ PCMH Resources
• Accreditation Support Resources
– Joint Commission ConnectTM (Extranet)
o Perspectives - Joint Commission’s official
monthly e-periodical
o Survey Activity Guide
– Joint Commission Resources (JCR)
o Ambulatory Care standards available in print and
electronic formats
o Ambulatory Care conferences and webinars on
accreditation and Primary Care Medical Home
certification
42
Distinguishing Features of
Joint Commission Accreditation
• Staff & Service
– Dedicated Account Executive & Project Director
– Certified and salaried surveyors: ongoing training
& evaluation
– Standards Interpretation Staff
– Electronic Manual (“E-dition”)
– Short report turn-around time
• Education & Training Resources
– Publications
- Webinars & Teleconferences
– Mock surveys
- Training Conferences
43
Distinguishing Features of
Joint Commission Accreditation
• Name Recognition
– All Settings (Lab/Behavioral
Health)
– Accreditation for 3 year
period
• State of the Art
Standards
– National Patient Safety
Goals
– Levels of Criticality
•
Accreditation
Process
– On-site survey tracers,
consultative, leading
practices & written report
– First survey scheduled then
re-surveys unannounced
– Periodical Performance
Review
– Certifies and accredits your
entire organization for a 3
year period, and
– Provides assistance to
attain/maintain accreditation
& PCMH throughout the
process.
44
Request The Joint Commission
for your Quality Initiative
• If you want:
Both Primary Care Medical Home certification and
accreditation that’s integrated into one on-site survey…
…by surveyors who are familiar with Health Centers and
who provide suggestions for how to meet any noncompliant requirements…
…using an tracer-based evaluative approach that doesn’t
require any additional application time or resources…
- Certifies and accredits your entire organization for a 3 year
period, and…
- Provides assistance to attain/maintain accreditation &
PCMH throughout the process.
45
FOR MORE INFORMATION
• Michael Kulczycki, Executive Director Ambulatory
Health Care Accreditation:
630-792-5290
[email protected]
• Lon Berkeley,
– Co-Project Lead, PCMH Initiative
– Project Director, Community Health Center
Accreditation
630-792-5787
[email protected]
46
NCQA’s
Patient-Centered Medical Home (PCMH)
Program
William Tulloch
Director, Government Recognition Initiatives
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NCQA
Private, independent non-profit health care quality oversight
organization founded in 1990
________________________________________________
MISSION
To improve the quality of health care.
VISION
To transform health care through
quality measurement, transparency, and accountability.
______________________________________________
ILLUSTRATIVE PROGRAMS
HEDIS® – Healthcare Effectiveness Data and Information Set
* Health Plan Accreditation * Clinician Recognition
* Disease Management Accreditation * Wellness & Health Promotion Accreditation
•* Quality Compass™
48
NCQA Recognition Program
• > 30,910 Clinician Recognitions nationally across
all Recognition programs (as of 12/31/11)
• Clinical programs
– Diabetes Recognition Program (DRP)
– Heart/Stroke Recognition Program (HSRP)
– Back Pain Recognition Program (BPRP)
• Practice process and structural measures
– Physician Practice Connections (PPC) – includes
specialty practices
– Physician Practice Connections-Patient-Centered
Medical Home (PPC-PCMH) 2008
– NCQA Patient-Centered Medical Home (PCMH) 2011
49
PCMH 2011 Standards and Scoring
PCMH1: Enhance Access and Continuity
Pts
A.
B.
C.
D.
E.
F.
4
4
2
2
2
2
G.
Access During Office Hours**
After-Hours Access
Electronic Access
Continuity
Medical Home Responsibilities
Culturally and Linguistically Appropriate
Services
Practice Team
4
20
PCMH2: Identify and Manage Patient
Populations
Pts
A.
B.
C.
D.
3
4
4
5
PCMH4: Provide Self-Care Support and
Community Resources
Pts
A.
B.
6
3
Support Self-Care Process**
Provide Referrals to Community Resources
9
PCMH5: Track and Coordinate Care
Pts
A.
B.
C.
6
6
6
Test Tracking and Follow-Up
Referral Tracking and Follow-Up**
Coordinate with Facilities/Care Transitions
18
PCMH6: Measure and Improve
Performance
Pts
16
A.
B.
C.
4
4
4
PCMH3: Plan and Manage Care
Pts
D.
A.
B.
C.
D.
E.
4
3
4
3
3
E.
F.
Patient Information
Clinical Data
Comprehensive Health Assessment
Use Data for Population Management**
Implement Evidence-Based Guidelines
Identify High-Risk Patients
Care Management**
Manage Medications
Use Electronic Prescribing
17
Measure Performance
Measure Patient/Family Experience
Implement Continuously Quality
Improvement**
Demonstrate Continuous Quality
Improvement
Report Performance
Report Data Externally
3
3
2
20
**Must Pass Elements
51
The NCQA PCMH Recognition
Process
Practice:
1. Obtains PCMH 2011 Standards and Guidelines
-- Available free from NCQA Publications
2.
Participates in NCQA trainings
3.
Obtains Survey Tool and online application account
4.
Self-assesses current performance on survey
5.
Submits online application to submit final survey
6.
Receives email confirmation that practice can submit
Survey Tool and documentation
7.
Submits Survey Tool and application when ready
52
Survey
Process
NCQA
•
•
•
•
•
•
•
•
Reviews submitted Survey Tool
Checks licensure of all clinicians
Evaluates Survey Tool responses, documentation, and explanations
Conducts an audit by email, teleconference, or on-site visit of 5% of
final surveys
Executive reviewer conducts a secondary review
Peer review by trained Recognition Program Oversight Committee
(RP-ROC) member
Issues final decision and status to the practice within 30 – 60 days
Reports results


•
Recognition posted on NCQA Web site
Not passed - not reported
Mails PCMH certificate and Recognition packet
53
PCMH Scoring & Outcomes
6 standards = 100 points
6 Must Pass elements
NOTE: Must Pass elements require a ≥ 50% performance level to pass
Level of Qualifying
Points
Must Pass Elements
at 50% Performance Level
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
Practices with a numeric score of 0 to 34 points and/or achieve less than 6
“Must Pass” Elements are not Recognized.
NCQA Personnel
• Government Recognition Initiatives Team
– Dedicated team government-related PCMH projects
o Patient-Centered Medical/Health Home Initiative
o CMS Advanced Primary Care Practice Demonstration
Project
• Surveyors
– NCQA-trained contract surveyors and staff members
• Executive Reviewers
– NCQA staff w/ extensive training in PCMH Program
• Review Oversight Committee
– Physicians from health plans and medical groups with
PCMH experience and NCQA training
56
PCMHHI and NCQA
• Interested health centers must file Notice of Intent with
HRSA
– Indicates Center is within 12 months of Recognition
• Centers can attend monthly trainings – conference calls
and Webinars
– Standards and Survey Process/Interactive Survey
System
• Mock Surveys also available
– Opportunity for feedback from trained surveyors
– Highlights areas on which center should focus
57
PCMHHI and NCQA cont.
• Survey Preparation
– Time to prepare depends on practice’s current ability to
function as a medical home
– Minimum 3 months experience with policies, procedures,
protocols and electronic systems
– Most sites take 12 – 18 months to prepare
• Survey Completion
– Survey Tool takes approximately 80 hours of staff time
to complete
– Most sites spend 3 – 4 months processing and finalizing
Survey Tool
• Recognition period of 36 months
58
NCQA Contact Information
Contact NCQA Customer Support to:
• Acquire standards documents, application account,
and survey tools
• Questions about your user ID, password, access
• 1-888-275-7585
Visit NCQA Web Site to:
• View Frequently Asked Questions
• View Recognition Programs Training Schedule
Submit questions to [email protected]
Please use this e-mail box to:
• Ask about interpretation of standards or elements
• Request registration for Interactive Survey System Survey Tool
demonstration (Web-ex)
59
Summary
• Many paths to PCMH
• Check for state and payer initiatives
• Important timelines
– 12 months to complete a survey in HRSA’s initiatives
o Must achieve at least a Level 1 recognition
– PCMH Supplemental Requirements
o Must submit an NOI to any (Federal, State, Private
Payer) PCMH initiative by 9/18/2012.
– CMS APCP Demonstration
o Must achieve Level III through NCQA by 10/31/2014
60
HRSA PCMHHI
Recognition Process
NOIs
HRSA
Accrediting or
Recognizing
Organization
HRSA Accreditation
HRSA PCMHHI
State/Payer
CMS
Demo
Surveys
Completed
RECOGNIZED
12 Months
NCQA
RECOGNIZED
Level III
36 Months
Summary
• Keep your Project Officer up to date on your progress,
successes, and barriers.
• PCMH transformation is a process that takes time.
• Technical assistance is available through a number of
organizations.
62
Resources
• Accreditation/Recognition Comparison Chart
– http://bphc.hrsa.gov/policiesregulations/policies/pcmhrec
ognition.pdf
• Quality Improvement Initiatives Fact Sheet
– http://bphc.hrsa.gov/policiesregulations/policies/qiovervie
w.pdf
• TA Resources
– http://www.pcdc.org/resources/patient-centered-medical-home/pcdcpcmh/ncqa-2011-medical-home.html
– http://www.transformed.com/userLogin.cfm
– http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/
1483
63
Questions?
64