As the patient-centered medical home, or PCMH, model of health care gains prominence in the United States, a number of entities are developing or offering medical home recognition or accreditation programs. This has led the AAFP, along with the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association, to create guidelines for PCMH recognition/accreditation programs to ensure that they are somewhat standardized.
Guidelines for Patient-Centered Medical Home Recognition and Accreditation Programs builds on the Joint Principles of the Patient-Centered Medical Home, which also were developed by the four groups and adopted in February 2007. A second, related document, the Joint Principles for the Medical Education of Physicians as Preparation for Practice in the PCMH, was adopted by the groups in December 2010.
According to Bruce Bagley, M.D., AAFP medical director of quality improvement, two nonprofit groups -- the National Committee for Quality Assurance(www.ncqa.org) and the Accreditation Association for Ambulatory Health Care(www.aaahc.org) -- already have established recognition or accreditation programs. Two other nonprofit organizations -- The Joint Commission(www.jointcommission.org) and URAC(www.urac.org) (formerly known as the Utilization Review Accreditation Commission) -- are expected to have programs in place by the middle of this year.
One of the Academy's flagship tools to aid members in achieving recognition as a patient-centered medical home, or PCMH, is the Road to Recognition guide, which helps members choose the level of medical home recognition they want to achieve and determine which PCMH elements their practice will document to achieve that goal.
Members also should check out the many PCMH-related tools and resources available from the AAFP's wholly owned subsidiary, TransforMed(www.transformed.com), including its Medical Home Implementation Quotient, or MHIQ, medical practice self-assessment. MHIQ lets physicians gauge where their practice is in the journey to becoming a PCMH by measuring the practice's performance across nine core sets of competencies.
"With four organizations accrediting or recognizing medical homes, we decided to develop guidelines to evaluate these programs. We want people to pay attention to what is important for patients," said Bagley.
The original PCMH joint principles comprise seven foundational components:
- the concept of the personal physician,
- a physician-directed, team-based approach to medical practice,
- a whole-person orientation,
- coordinated and integrated care,
- quality and safety,
- enhanced access, and
- appropriate payment framework.
The new guidelines say that all PCMH recognition or accreditation programs should incorporate the joint principles of the PCMH. Specifically, such programs should
- address the complete scope of primary care services;
- ensure the incorporation of patient and family-centered care, emphasizing engagement of patients, their families and their caregivers;
- engage multiple stakeholders in the development and implementation of the programs;
- identify essential standards, elements and characteristics;
- align standards, elements, characteristics and/or measures with "meaningful use" requirements;
- address the core concept of continuous improvement that is central to the PCMH model;
- allow for innovative ideas;
- acknowledge care coordination within the medical neighborhood;
- clearly identify PCMH recognition or accreditation requirements for training programs;
- ensure transparency in program structure and "scoring";
- apply reasonable documentation and data collection requirements, and
- conduct evaluations of program effectiveness and implement improvements.
According to Bagley, the most important PCMH joint principles concerning program accreditation and recognition are those that address the comprehensiveness of care and the team approach to medical practice.
"The medical home can't be a referral hub that just sends patients to a (sub)specialist," said Bagley. "The comprehensive, personalized nature of care and the team approach are the essential things."
Bagley also noted that these recognition and accreditation systems are oriented to processes and are not designed to address the efficiency and economic benefits of the medical home in the health care system.
"It is important to realize that none of these recognition programs gives a complete and fair assessment of the value of primary care to patient outcomes or to the system in terms of cost savings," he said.