The patient-centered medical home is one step closer to becoming a pillar in the foundation of America's health care system with the recent launch of a physician practice recognition program. The National Committee for Quality Assurance, or NCQA, a private not-for-profit organization dedicated to improving health care quality, introduced its Physician Practice Connections -- Patient-Centered Medical Home, or PPC-PCMH, program in January.
Patient-Centered Medical Home
NCQA Fires Up National Recognition Program
By Sheri Porter
2/7/2008
AAFP Lends Support
The Academy's Board of Directors has endorsed NCQA's program for use in designating family medicine practices as patient-centered medical homes in pilot projects that are sprouting up around the country, such as those associated with Bridges to Excellence.
AAFP President Jim King, M.D., of Selmer, Tenn., said that the AAFP is working closely with NCQA because the organization is the furthest along in promoting recognition of the medical home process. "The future of family medicine lies with FPs who are able to provide patients with a patient-centered medical home that is recognized and valued by patients, businesses, government and private payers," said King.
The Academy expects FPs to be paid a care management fee and to be paid extra for participating in pay-for-performance programs, he said. "Our plan is to base our arguments for higher rates of payment on the patient-centered medical home," and family medicine practices should strive to meet the criteria that have been set up, he said.
"Understand that the work spent now in preparing to become a medical home is done with an eye to the future," said King. "We're looking at better payment down the road."
AAFP President Jim King, M.D., of Selmer, Tenn., said that the AAFP is working closely with NCQA because the organization is the furthest along in promoting recognition of the medical home process. "The future of family medicine lies with FPs who are able to provide patients with a patient-centered medical home that is recognized and valued by patients, businesses, government and private payers," said King.
The Academy expects FPs to be paid a care management fee and to be paid extra for participating in pay-for-performance programs, he said. "Our plan is to base our arguments for higher rates of payment on the patient-centered medical home," and family medicine practices should strive to meet the criteria that have been set up, he said.
"Understand that the work spent now in preparing to become a medical home is done with an eye to the future," said King. "We're looking at better payment down the road."
Program Details
The NCQA program uses standards that are aligned with the joint principles of the medical home (3-page PDF; About PDFs) established by the AAFP, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.
Practices seeking PPC-PCMH recognition must complete a Web-based survey and provide documentation that validates their responses. The NCQA evaluates the practice data and documents and scores the practice using a point system.
According to the NCQA scoring system, (1-page PDF; About PDFs) a practice must score
Practices seeking PPC-PCMH recognition must complete a Web-based survey and provide documentation that validates their responses. The NCQA evaluates the practice data and documents and scores the practice using a point system.
According to the NCQA scoring system, (1-page PDF; About PDFs) a practice must score
- 25-49 points, including at least a 50 percent performance level in five of the 10 must-pass elements, to qualify at a level one;
- 50-74 points, including at least a 50 percent performance level in all 10 must-pass elements, to qualify at a level two; and
- 75-100 points, including at least a 50 percent performance level in all 10 must-pass elements, to qualify at a level three.
Practices can increase their level of recognition as they implement and achieve more of the requirements.
There is some cost associated (3-page PDF; About PDFs) with the NCQA program, including $80 to purchase a license to the NCQA survey tool. Application fees for NCQA review and recognition are $450 each for as many as six physicians in a practice. Practices with more than six physicians pay a flat fee of $2,700.
There is some cost associated (3-page PDF; About PDFs) with the NCQA program, including $80 to purchase a license to the NCQA survey tool. Application fees for NCQA review and recognition are $450 each for as many as six physicians in a practice. Practices with more than six physicians pay a flat fee of $2,700.
AAFP Resources
King acknowledged that many physicians may need help getting started with the process of becoming a patient-centered medical home and said that the Academy is gearing up to offer assistance. He cited AAFP's Practice Support Division, its Center for Health Information Technology, and TransforMED, a practice redesign initiative affiliated with the Academy, as three resources members could use.
"I'm a practicing physician; I know how hard it is to read through all the documents and try to decide what it is I need to do," said King.
TransforMED CEO Terry McGeeney, M.D., said NCQA's three-level program was constructed to make the task of qualifying for recognition easier for physicians. "If practices had to do everything all at once to get to level three, they might find that daunting and not even try."
McGeeney stressed that NCQA and TransforMED fulfill different roles in the process. "The role of NCQA is to recognize practices that have met certain criteria. The role of TransforMED is to help practices get there," said McGeeney. "We're not in the recognition business, and NCQA is not in the facilitation business."
McGeeney pointed out that TransforMED's two-year national demonstration project ends on May 31. "Our new mission, beginning June 1, is to support practices in this transformative process. By summer, we'll be rolling out the full TransforMED product line with levels of consultation and facilitation," he said.
"I'm a practicing physician; I know how hard it is to read through all the documents and try to decide what it is I need to do," said King.
TransforMED CEO Terry McGeeney, M.D., said NCQA's three-level program was constructed to make the task of qualifying for recognition easier for physicians. "If practices had to do everything all at once to get to level three, they might find that daunting and not even try."
McGeeney stressed that NCQA and TransforMED fulfill different roles in the process. "The role of NCQA is to recognize practices that have met certain criteria. The role of TransforMED is to help practices get there," said McGeeney. "We're not in the recognition business, and NCQA is not in the facilitation business."
McGeeney pointed out that TransforMED's two-year national demonstration project ends on May 31. "Our new mission, beginning June 1, is to support practices in this transformative process. By summer, we'll be rolling out the full TransforMED product line with levels of consultation and facilitation," he said.
Exploring the Local Market
Bruce Bagley, M.D., AAFP's medical director for quality improvement, said that "with some documentation and minor process changes, most practices could accumulate the 25 points necessary to reach level one." He suggested that physicians consider investing $80 to purchase the NCQA assessment tool to see where they are on the medical home continuum.
Both Bagley and King advised physicians to look around their communities to see if any organizations or health plans are offering extra cash to physicians for participating in pay-for-performance programs or medical home pilot projects.
"There's no reason for a practice to spend $450-plus for NCQA recognition until some players in the physician's local market have put money on the table," said Bagley.
Both Bagley and King advised physicians to look around their communities to see if any organizations or health plans are offering extra cash to physicians for participating in pay-for-performance programs or medical home pilot projects.
"There's no reason for a practice to spend $450-plus for NCQA recognition until some players in the physician's local market have put money on the table," said Bagley.
