NCQA. Four letters that stir strong emotions in the heart of almost any family physician who has tried to achieve patient-centered medical home (PCMH) recognition from that organization -- the National Committee for Quality Assurance. I know this not only because I've heard from AAFP members who have been through the long, tedious and costly process, but because I've done it myself -- twice.
Amy Mullins, M.D.
But what's important to realize is that NCQA has for years been an important partner in advancing the PCMH. Since 2007, the AAFP has worked closely with the organization to advance practice transformation based on the PCMH Joint Principles(3 page PDF), and it now looks as though those efforts are paying off.
More on that later.
NCQA's current PCMH recognition process requires a practice to submit all its materials for a full review with little guidance from the organization. It's a bit like trying to talk to the Wizard of Oz while he hides behind the curtain. You're not sure what NCQA wants or whether you are doing it right, and you don't get any feedback until you've completed the task.
Does it really have to be this hard? And does recertification need to be just as arduous?
I recently talked with a family physician whose practice had achieved NCQA Level 3 recognition and then had followed up by jumping through the required hoops to recertify. But after completing the process for the second time, this FP was told his practice was no longer a Level 3 medical home. In fact, NCQA deemed that the practice, in three years, had somehow regressed from the organization's highest level of PCMH recognition to a point at which it did not even meet Level 1 criteria.
He was told, however, that he was welcome to try again -- for an additional fee.
Needless to say, he wasn't happy. To that member's credit, he was proactive and resolved the issue with NCQA without having to make another payment and without completing the process a third time.
But his sharing his story with me helped lead to productive conversations between the Academy and NCQA. When NCQA staff asked us for suggestions on how to improve the organization's recognition process and how to make it more meaningful, we were more than happy to respond based on feedback we have heard from that family physician and numerous others from across the country.
We told NCQA that its staff should be available to facilitate transformation from the moment they receive payment from a practice. And they should answer practices' questions about the technical aspects of the application.
We also said NCQA needed to change the framework of its process so that practices only have to certify only once versus every two to three years. Doing so would allow practices to secure recognition and then focus on process and quality improvement in subsequent years, working closely with NCQA on these efforts.
The good news is that NCQA not only heard our concerns, it says it plans to do something about them. We hope that more collaborative, ongoing relationships between NCQA and practices will develop. We don't yet know all of the details about the changes that will be made to its process, but NCQA has heard our frustrations, and here's a brief look at what we do know about the planned changes:
- Practices will be assigned a "navigator" (an NCQA staff member) who can help guide physicians and staff through the process.
- The navigator will be available to help answer questions about the application itself and what documentation is needed to fulfill certain standards.
- Information will be gathered and submitted at agreed-on intervals until recognition is achieved -- rather than all at once at the end of the process.
- Recognition will be sustained and will not require renewal. Certain data will need to be submitted annually to facilitate sustained recognition, but practices will no longer face a wholesale renewal every three years.
It's unclear when the new changes will be fully implemented, but the AAFP will continue to work with NCQA to inform members about the progress made. The organization just introduced new standards last year, so it likely won't happen overnight.
Meanwhile, it's worth noting that NCQA isn't the only option when it comes to being recognized as a PCMH. There are several certification bodies nationally, and some that operate locally, that can facilitate your recognition process. Evaluate your practice environment and make the business decision that is right for you. If payment is enhanced in your market for medical home recognition, then it may be the right thing for your practice.
No change is ever easy, and sustaining change is sometimes even harder, so I applaud those of you who are continuing to do this work each day. NCQA is a long-standing partner and collaborator, and we value our relationship with them. However, we understand that our first obligation is to our members and patients. This is why we are being proactive in our efforts with NCQA, and we're pleased that these efforts are driving improvements. I hope the new NCQA process is less burdensome for everyone and that it will promote meaningful practice transformation.
Amy Mullins, M.D., is the AAFP medical director for quality improvement.