Transcript Documentation

Patient-Centered Specialty Practice
(PCSP) Recognition Program
Standards Workshop Part 2
All materials © 2013, National Committee for Quality Assurance
Agenda Part 1
• Content of PCSP Standards and Guidelines
– Standards 1 – 3
– Documentation Examples*
Agenda Part 2
• Content of PCSP Standards and Guidelines
– Standards 4 – 6
– Documentation Examples*
*Examples in the presentation only illustrate the element intent. They
are NOT definitive nor the only methods of documenting how the
requirements may be met.
2
PCSP 4: Plan and Manage Care
Intent
• Collaborate with
patient/family/caregiver
and PCP to develop and
implement care plan
• Review and reconcile
medications
• E-prescribe
Meaningful Use
• Use EHR to identify patient
education resources
• Review and reconcile
medications
• Use an e-prescribing
system to write and
transmit prescriptions
• Compare meds. With
formularies, check for
generics, drug-drug and
drug-allergy interactions
3
PCSP 4: Plan and Manage Care
Elements
• PCSP 4A: Care Planning
and Self-Care Support
• PCSP 4B: Medication
Management - MUST PASS
• PCSP 4C: Use of Electronic
Prescribing
4
PCSP 4A: Care Planning and Self-Support
The practice provides the following care management
and self-care support for practice-specific conditions:
1. Conduct pre-visit preparations
2. Assess patient risk status to identify patients needing
additional support and services
3. Collaborate with the patient/family/caregiver to
develop a specialist’s plan of care that includes
patient’s goals, potential barriers/self-care ability CRITICAL FACTOR
4. Share specialist’s plan of care including
recommendations for self-care support with the PCP
and referring clinician - CRITICAL FACTOR
5
PCSP 4A: Care Planning and Self-Support
The practice provides the following care management
and self-care support for practice-specific conditions:
5. Give the patient/family/caregiver a written specialist’s
plan of care including self-care recommendations.
6. Provide educational resources or refer
patients/families/caregivers to assist in selfmanagement
7. Assess/address barriers when patient has not met
treatment goals
8. Use an EHR to identify patient-specific education
resources and provide to more than 10 percent of
patients+
+ Stage 2 Core Meaningful Use Requirement
6
PCSP 4A: Care Planning and Self-Support
• 11 Points
• Scoring
–
–
–
–
–
•
100% - 6-8 factors, including Factors 3 and 4
75% - 4-5 factors, including Factors 3 and 4
50% - 2-3 factors, including Factors 3 and 4
25% - No scoring option
0% - 0-1 factor, or does not meet Factors 3 and 4
Documentation
– Factors 1-7: Written process and examples
– Factor 8: Report with numerator, denominator and
percentage
7
PCSP 4A: Example Pre-visit Form
Patients complete form pre-visit:
 Focus of today’s visit
 Medications
 Allergies
 Pain assessment
 Flu vaccine
 Depression assessment
 Recent ER visit
8
PCSP 4A: Example Patient Education
Prenatal Care: Steps Toward a Healthy Pregnancy
Prenatal Session #1
PROGRAM: Comprehensive Perinatal Services Program TIME: 1-1 ½ Hours
OBJECTIVES
By the end of the session, the participant will be able to:
1. Identify basic anatomy of human reproductive system
2. Identify common discomforts of pregnancy including aspects of fetal growth and
development
3. Identify danger signs during pregnancy and action to take
during complications
4. Identify lab tests including the importance of ultrasound
5. Understand the importance of Oral health during pregnancy
Practice must also attach a complete set of education materials that could be
provided to the patient.
9
PCSP 4B: Medication Management
The practice has a process and demonstrates that it
systematically manages medications prescribed by
the practice in the following ways:
1. Reviews and reconciles medications for more than
50 percent of patients received from another care
setting or a relevant visit+
2. Provides information about new prescriptions from
specialty practice to patients/families/caregivers.
3. Coordinates medication management and
reconciliation with the PCP, referring clinician and
patient/family/caregiver
10
PCSP 4B: Medication Management
The practice has a process and demonstrates that it
systematically manages medications prescribed by
the practice in the following ways:
4. Assesses patient/family/caregiver understanding
of medications from specialty practice
5. Assesses patient response to medications from
specialty practice and barriers to adherence
6. Documents over-the-counter medications, herbal
therapies and supplements
+ Stage 2 Core Meaningful Use Requirement
11
PCSP 4B: Medication Management
• Must Pass
• 5 Points
• Scoring
–
–
–
–
–
100% - 5-6 factors
75% - 4 factors
50% - 3 factors
25% - 2 factors
0% - 0-1 factors
• Documentation:
– Factor 1: Report with numerator, denominator and percentage
– Factors 2-6: Documented process and three examples for each
factor
12
PCSP 4B: Example Medication Reconciliation
Reconcile meds. at each visit for patient
safety and effectiveness of medications
1. Pts. bring list or meds. to each visit; reminded
when appt. scheduled; signs in pt. rooms
2. Med. asst. reviews meds. at each visit
3. MD reviews current meds.; discusses pt.
concerns
4. Motivational interviewing/shared decisionmaking to help with risks/benefits of meds.
5. MD/staff teach pt. about med. administration
6. Follow-up call to pt. when major change to
meds.
7. Check with pt. if refill requests are conflicting
13
PCSP 4B: Patient Role in Med. Management
Posted in office to
encourage patients to
help managing their
medications
14
PCSP 4C: Use of Electronic Prescribing
The practice uses an electronic prescription system with the following:
1. Writes at least 75 percent of eligible prescriptions electronically.
2. More than 50 percent of eligible prescriptions written by the
practice are compared to drug formularies and electronically
sent to pharmacies+
3. Enters electronic medication orders into the medical record for
more than 60 percent of patients with at least one medication in
their medication list+
4. Performs patient-specific checks for drug-drug and drug-allergy
interactions+
5. Alerts prescriber to generic alternatives
+ Stage 2 Core Meaningful Use Requirement
15
PCSP 4C: Use of Electronic Prescribing
• 2 Points
• Scoring
–
–
–
–
–
100% - 3-5 factors
75% - 2 factors
50% - 1 factor
25% - No scoring option
0% - 0 factors
VS
• Documentation
– Factors 1-3: Report with a numerator, denominator and
percentage
– Factors 4 and 5: Report or screen shot demonstrating
capability
16
PCSP 4C: Example Electronic Prescription
Writing
Prescription Writing Activity
Electronic
57%
2563 Rx
Printed, given to patient
31%
1419 Rx
Print, fax to pharmacy
1%
89 Rx
_______________________________________
TOTAL
Rx
4474 Rx
% E-RX
89%
17
PCSP 4C: Example Drug-Drug Interactions
Drug-Drug
Interactions
18
PCSP 4C: Example Prescription Allergy
19
PCSP 4C: Example Generic Alternatives
20
PCSP 5: Track and Coordinate Care
Intent
• Track/follow-up on lab
and imaging results
• Exchange test results
with primary care
• Track/follow-up on
referrals
• Coordinate with
hospitals/ ERs; transition
patients back to
primary care
Meaningful Use
• Incorporate clinical lab test
results into the medical
record
• Electronically exchange
clinical information with
other clinicians and
facilities
• Provide electronic
summary of care record for
referrals and care
transitions
CMS EHR Incentive Programs: http://www.cms.gov/Regulationsand-Guidance/Legislation/EHRIncentivePrograms/index.html
21
PCSP 5: Track and Coordinate Care
Elements
PCSP 5A: Test Tracking and Follow-Up
PCSP 5B: Referral Tracking and Follow-Up
PCSP 5C: Coordinate Care Transitions
22
PCSP 5A: Test Tracking and Follow-Up
The practice has a documented process for and
demonstrates that it:
1. Requests and tracks receipt of test results from PCP and
referring clinician
2. Provides PCP and referring clinician with results of
relevant tests ordered by the specialist - CRITICAL
FACTOR
3. Tracks lab tests until results are available, flagging and
following up on overdue results
4. Tracks imaging tests until results are available, flagging
and following up on overdue results
5. Flags abnormal lab results, bringing them to the
attention of the clinician
23
PCSP 5A: Test Tracking and Follow-Up (cont.)
The practice has a documented process for and
demonstrates that it:
6. Flags abnormal imaging results, bringing them
to the attention of the clinician
7. Patients/families/caregivers are notified about
normal and abnormal lab and imaging test
results
8. More than 30 percent of laboratory orders are
electronically recorded in the patient record+
24
PCSP 5A: Test Tracking and Follow-Up (cont.)
The practice has a documented process for and
demonstrates that it:
9. More than 30 percent of radiology orders are
electronically recorded in the patient record+
10. Electronically incorporates more than 55 percent
of all clinical lab test results into structured fields in
medical record+
11. More than 10 percent of scans and tests that result
in an image are accessible electronically++
+ Stage 2 Core Meaningful Use Requirement
++ Stage 2 Menu Meaningful Use Requirement
25
PCSP 5A: Test Tracking and Follow-Up
• 5 Points
• Scoring
–
–
–
–
–
100% - 6-11 factors, including factor 2
75% - 4-5 factors, including factor 2
50% - 3 factors, including factor 2
25% - 1-2 factors, including factor 2
0% - 0 factors or does not meet factor 2
• Documentation
– Factors 1-7: Documented process and report with 5 days of
data or three examples of meeting the process for each factor
(demonstrate the implemented process)
– Factors 8, 9, 10, 11: Report with a numerator, denominator and
percentages
26
PCSP 5A: Example, Lab Process
Missing Flagging
Overdue labs and FU
27
PCSP 5A: Policy for Abnormal Test Results
Policy: Definitions for
Abnormal Test Result
Categories and Reporting
Requirements for Each
• Abnormal
• Abnormal (Priority)
• Abnormal (Critical)
28
PCSP 5A: Example Referral Tracking
29
PCSP 5A: Example Test Tracking Log
DATA COLLECTED
 Patient name
 DOB
 Provider
 Order date
 Test ordered
 Urgency
 Date results received
 Results normal/abnormal
 Date results to provider
 Date results to patient
30
PCSP 5A: Example Electronic Test Tracking
All lab and imaging tests are
tracked until results are
available
Overdue results are flagged
Abnormal results are
flagged
Practice tracks:
 Date ordered
 Overdue
 Abnormal
 Priority
 Patient name
 Provider
 Order description
 Last appointment
 Next appointment
31
PCSP 5A: Example Letter for Patient
Notification of Abnormal Imaging Results
Patient/family was notified by
provider of abnormal test results
and given follow-up instructions
32
PCSP 5B: Referral Tracking and Follow-Up
The practice coordinates referrals to other
(secondary) specialists by:
1. Consulting with PCP and referring clinician and
patient/family/ caregiver regarding secondary
referrals
2. Giving the consultant or specialist the clinical reason
for the referral and pertinent clinical information CRITICAL FACTOR
3. Tracking the status of the referral, including required
timing for receiving a specialist’s report
4. Following up to obtain specialist’s report
33
PCSP 5B: Referral Tracking and Follow-Up
(cont.)
The practice coordinates referrals to other
(secondary) specialists by:
5. Establishing and documenting agreements with
specialists in the medical record if co-management is
needed
6. Asking patients/families/caregivers about self-referrals
and requesting reports from clinicians
7. Assuring the PCP and original referring clinician are
notified of the secondary referral results.
8. Providing an electronic summary of care record to
another provider for more than 50 percent of referrals+
34
PCSP 5B: Referral Tracking and Follow-Up
(cont.)
The practice coordinates referrals to other
(secondary) specialists by:
9. Electronically transmitting a summary of care record
to another care provider for more than 10 percent of
care referrals+
10. Conducting one or more successful electronic
exchanges with a recipient who has technology
developed by a different EHR developer or
successfully tests with the CMS designated test EHR.+
+ Stage 2 Core Meaningful Use Requirement
35
PCSP 5B: Referral Tracking and Follow-Up
• 6 Points
• Scoring
–
–
–
–
–
100% - 8-10 factors, including Factor 2
75% - 6-7 factors, including Factor 2
50% - 4-5 factors, including Factor 2
25% - 1-3 factors, including Factor 2
0% - 0 factors
• Documentation
– Factors 1-4, 6&7:
1. Documented process and
2. Reports or logs showing data collection in a tracking system
– Factor 5: At least three examples
– Factors 8 and 9: Report with numerator, denominator and
percentages
– Factor 10: Screen shot showing capability
36
PCSP 5B: Example Referral Tracking
Referral Tracking Data - 5 days
• Date ordered
• Referring provider
• Diagnosis
• Referred to
• Supporting clinical information
• Urgency
• Type of referral
• Appointment date
• Date results received
• Date of follow-up for missing report
37
PCSP 5B: Example Co-Management Policy
38
PCSP 5B: Example Follow-Up to
Get Referral Report
39
PCSP 5C: Coordinate Care Transitions
For conditions managed by the specialist, the
practice systematically:
1. Demonstrates its process for identifying
patients with a hospital admission and patients
with an emergency department visit
2. Demonstrates its process for sharing clinical
information with admitting hospitals or
emergency departments
3. Demonstrates its process for consistently
obtaining patient discharge summaries from
the hospital and other facilities
cont.
40
PCSP 5C: Coordinate Care Transitions (cont.)
For conditions managed by the specialist, the practice
systematically:
4. Demonstrates its process for transitioning patients back
to the primary care practice
5. Provides an electronic summary-of-care record to
another care facility for more than 50 percent of
transitions of care+
6. Electronically transmits a summary of care record to
another care setting for more than 10 percent of care
transitions+
+ Stage 2 Core Meaningful Use Requirement
41
PCSP 5C: Coordinate Care Transitions
• 5 Points
• Scoring
–
–
–
–
–
100% - 4-6 factors
75% - 3 factors
50% - 2 factors
25% - 1 factor
0% - 0 factors
• Documentation
– Factors 1-4:
1. Documented process and
2. Three examples
– Factors 5 and 6: Report with a numerator, denominator
and percentages
42
PCSP 5C: Example Identifying Patients in
Facilities
Practice receives admission
reports electronically from
hospital
43
PCSP 5C: Example ER Visit Follow-Up Log
44
PCSP 5C: Pediatric to Adult Transition
Diabetes Care Self-Assessment
Self-assessment of worries,
concerns, burdens related to diabetes
and preparation for transitioning
I would like to talk about:
• Challenged by diabetes burdens
• Social/emotional/cognitive issues
• Transition preparation/readiness to
move on
45
PCSP 5C: Clinical Summary for New Health
Care Team
46
PCSP 6: Measure and Improve Performance
Intent
• Measure clinical
performance,
coordination of care,
utilization affecting
costs, access to care,
patient experience and
report performance
• Use and monitor
effectiveness of quality
improvement process
Meaningful Use
Report:
• Ambulatory quality
measures to CMS
• Immunization data to
registries
• Syndromic surveillance
data to public health
agencies
• Cancer cases to
registry
47
PCSP 6: Measure and Improve
Performance
Elements
• PCSP 6A: Measure Performance
• PCSP 6B: Measure Patient/Family Experience
• PCSP 6C: Implement & Demonstrate
Continuous Quality Improvement - MUST
PASS
• PCSP 6D: Report Performance
• PCSP 6E: Use Certified EHR Technology
48
PCSP 6A: Measure Performance
The practice measures or receives data on:
1. At least three clinical measures related to the
practice specialty
2. Coordination of care results
3. At least two utilization measures affecting
health care costs
4. Performance data stratified for vulnerable
populations (to assess disparities in care).
5. Timely access to appointments
based on established criteria
49
PCSP 6A: Measure Performance
• 5 Points
• Scoring
–
–
–
–
–
100% - 4-5 factors
75% - 3 factors
50% - 1-2 factors
25% - No scoring option
0% - 0 factors
• Documentation
– Factors 1-5: Reports showing performance
50
Vulnerable Populations Defined
“Those who are made vulnerable by:
– their financial circumstances or place of
residence,
– health, age, personal characteristics,
– functional or developmental status, ability
to communicate effectively, and
– presence of chronic illness or disability.”
Source: AHRQ
51
Vulnerable vs. High Risk
52
PCSP 6A: Example Chronic Care Clinical
Measures
53
NCQA Clinical Program Recognition
Where Can it Be Used to Meet Elements?
• NCQA Clinical Recognition Programs
– Diabetes Recognition Program (DRP)
– Heart/Stroke Recognition Program (HSRP)
• Credit for Clinical Program Recognition may be used
for meeting some requirements if 75% of clinicians are
Recognized:
– PCSP 6A Factor 1
– PCSP 6C Factors 1 and 7 (if renewed), for Element A
portion
– PCSP 6 D Factor 1, 2 and 3 for Element A portion
54
NCQA Clinical Program Recognition
Where Can it Be Documented to Meet Elements?
55
PCSP 6A: Example
Measures Affecting Health Care Costs
PCSP6 ELEMENT A: Factor 3
PCMH
Care Managers receive referrals from PCP'S, Hospitalists, Social Workers or family members
requesting evaluation for patients to be treated at an alternative level of care (home, SNF) or in the
office. The team has had a 22% success rate in saving hospital admissions since Nov 2007.
CARE MANAGEMENT ACTIVITIES
2014 August - December
TOTAL CM REFERRALS / SAVED
ADMISSIONS
2014
2014
2014
2014
2014
TOTAL TO
DATE
AUG
SEPT
OCT
NOV
DEC
2014
TOTAL CM REFERRALS
220
202
299
221
219
1161
TOTAL CM REFERRALS
SAVED ADMISSIONS
57
53
55
49
57
271
SAVED ADMISSIONS
FAILED ATTEMPTS
5
7
2
3
3
20
FAILED ATTEMPTS
56
PCSP 6A: Example Data for Vulnerable
Populations
57
PCSP 6B: Measure Patient/Family Experience
The practice obtains feedback from patients/families on
their experiences with the practice and their care.
1. The practice conducts a survey (using any instrument) to evaluate
patient/family experiences on at least three of the following
categories:
–
–
–
–
Access
Communication
Coordination
Self-management support
2. The practice uses CAHPS** Clinician & Group (CG) Survey Tool
3. The practice obtains feedback on experiences of vulnerable
patient groups
4. The practice obtains feedback from patients/families through
qualitative means
**Consumer Assessment of Healthcare Providers and Systems (CAHPS)
https://www.cahps.ahrq.gov/clinician_group/
58
PCSP 6B: Measure Patient/Family Experience
• 5 Points
• Scoring
–
–
–
–
–
100% - 3-4 factors
75% - No scoring option
50% - 2 factors
25% - 1 factor
0% - 0 factors
• Documentation
– Factors 1-4: Provides reports with summarized results
of patient feedback. A blank Survey Tool does not
meet the intent of this element.
59
PCSP 6B: Example of Reported CAHPS
Questions for Patient Experience
60
PCSP 6B: Example Patient Experience Data
Jan 2015
March 2015
61
PCSP 6B: Example Patient Experience Survey Results
Survey questions include:
 Access
2014
2014
 Communication
 NEEDS A THIRD CATEGORY
62
PCSP 6C: Implement & Demonstrate
Continuous Quality Improvement
The practice demonstrates ongoing monitoring of
the effectiveness of its improvement process by:
1. Setting goals/acting to improve on at least
three clinical quality or utilization measures
2. Setting goals/acting to improve quality on at
least one patient experience measure
3. Setting goals/acting to improve timeliness of
patient access
4. Setting goals/acting to improve coordination
with primary care
63
PCSP 6C: Implement & Demonstrate
Continuous Quality Improvement
The practice demonstrates ongoing monitoring of the
effectiveness of its improvement process by:
5. Tracking results over time
6. Assessing the effect of its actions
7. Achieving improved performance on one
measure
8. Achieving improved performance on a second
measure
9. Setting goals and addressing at least one
identified disparity in care/service for vulnerable
populations
64
PCSP 6C: Implement & Demonstrate
Continuous Quality Improvement
• MUST PASS
• 4 Points
• Scoring
–
–
–
–
–
100% - 6-9 factors
75% - 4-5 factors
50% - 3-4 factors
25% - 2 factors
0% - 0-1 factor
• Documentation
– Factors 1- 9: Reports or completed PCSP Quality Measurement
and Improvement Worksheet
65
PCSP 6C: Quality Measurement and Improvement
Instructions
66
PCSP 6C: Quality Measurement and
Improvement Worksheet
 Measure (C)
 Performance Measures (A)
 Disparities in Care (A)
 Patient/Family Experience (B)
 Opportunity Identified (C)
 Initial Performance/
Measurement Period (A/B)
 Performance Goal (C)
 Action Taken and Date (C)
 Re-measurement Performance (C)
 Demonstrate Improvement (C)
67
PCSP 6C, Factor 5: Example Tracking
Data Over Time
Aug-14 Sep-14 Oct-14 Nov-14 Dec-14
68
PCSP 6D: Report Performance
The practice shares performance
data from Element A and Element B:
1. Within the practice, results by
individual clinician
2. Within the practice, results across
the practice
3. Outside the practice to patients or
publicly, results across the practice
or by clinician
69
PCSP 6D: Report Performance
• 2 Points
• Scoring
–
–
–
–
–
100% - 3 factors
75% - 2 factors
50% - 1 factor
25% - no scoring option
0% - 0 factors
• Documentation
– Factors 1-2: Reports to practice or clinicians and practice
staff; explains how results are provided
– Factor 3: Example of report to patients or the public
70
PCSP 6D: Example Reporting by Clinician
Blinded 6 Clinicians
1
2
3
4
5
6
71
PCSP 6D: Example Practice Level Diabetes
Data
Jan-2015
72
PCSP 6D: Example of External Reporting
73
PCSP 6E: Use Certified EHR Technology
1. The practice uses an EHR system (or modules) that has
been certified and issued a Certified HIT Products List
(CHPL) Number(s) under the ONC (Office of the National
Coordinator for Health Information Technology) HIT
certification program
2. The practice attests to conducting a security risk
analysis of its electronic health record (EHR) system (or
modules) and implementing security updates as
necessary and correcting identified security
deficiencies+
3. The practice demonstrates capability to submit
electronic syndromic surveillance data to public health
agencies electronically++
74
PCSP 6E: Use Certified EHR Technology (cont.)
4. The practice demonstrates capability to identify and report
cancer cases to a public health central cancer registry
electronically++
5. The practice demonstrates capability to identify and report
specific cases to a specialized registry electronically (other
than a cancer registry)++
6. The practice reports clinical quality measures to Medicare or
Medicaid agency as required for Meaningful Use.
7. The practice demonstrates the capability to submit electronic
data to immunization registries or immunization information
systems.+
+ 2 Core Meaningful Use Requirement
++Stage 2 Menu Meaningful Use Requirement
75
PCSP 6E: Use Certified EHR Technology
• 0 Points
• Documentation
– Factors 1-7: Responding
“yes” or “no” in each
element of the survey tool
is an attestation that the
practice meets the
respective requirements
76
Meaningful Use Attestation
Accepted Attestation
Attestation Tracking Information
Attestation Confirmation Number
77
NCQA Resources Available
Free training each month
http://www.ncqa.org/rptraining.aspx
• Getting On Board
 Includes How to Submit as a Multi-site
• Standards (2-part program)
• Software Training
 Using the ISS System
 The Online Application
78
NCQA Contact Information
Visit NCQA Web Site at www.ncqa.org to:
– Follow the Start-to-Finish Pathway
– View Frequently Asked Questions
– View Recognition Programs Training Schedule
For questions about interpretation of standards
or elements to submit a question to my.ncqa
(Policy/Program Clarification Support & Recognition Programs)
Contact NCQA Customer Support at
888-275-7585 M-F, 8:30 a.m.-5:00 p.m. ET
to:
– Acquire standards documents, application
account, survey tools
– Questions about your user ID, password,
access
79
Questions?
80