PCMH Standard 6

1

Patient Centered Medical Home 2011 Standards

2

PCMH 6

PCMH 6

PCMH 6

• Elements A-B

• Elements C-E

• Elements F-G

Today’s Agenda

MEASURE PERFORMANCE

Standard 6 A

PCMH 6A Measure Performance

PCMH 6A Factor 1 Sample Documentation

Our practice collects data on preventive service quality measures monthly and we report to our quality council quarterly on results. Attached are screenshots from our EMR on…

PCMH 6A Measure Performance

PCMH 6A Factor 2 Sample Documentation

Our practice receives data on CAD quality measures quarterly from our registry vendor. The results are presented to our QI committee for review and discussion. Attached are screenshots…

PCMH 6A Factor 2 Sample Documentation

Our practice receives data on CAD quality measures quarterly from our registry vendor. The results are presented to our QI committee for review and discussion. Attached are screenshots…

PCMH 6A Measure Performance

PCMH 6A Factor 3 Sample Documentation

Our clinic receives data from our local hospital on both Admissions and ED visits for 4 chronic conditions affecting our rural community.

Our clinic goals are to reduce both ED and hospital admissions for CAD, COPD, DM and HTN patients. Our data reflects significant decreases when compared to Q1 2011

PCMH 6A Measure Performance

Community Health Center, Section 330 (e) Migrant Health Center, Section 330 (g) Health Care for the Homeless, Section 330 (h) Public Housing Primary Care, Section 330 (i) All new grantees that receive Health Center grant awards and are operational by October of the reporting year are required to submit UDS reports.

PCMH 6A Factor 4 Documentation Options

Uniformed Data Set/ HRSA

Other options for documenting 6A factor 3

• ER visit data

• potentially avoidable hospitalizations/ readmissions

• Redundant imaging or labs tests

• Prescribing generic medications vs. brand name drugs

• Specialty referrals

PCMH 6A Factor 4 Sample Documentation

Standard 6 B

Patient Experience

New Focus on the Patient

PCMH 6B Measure Patient/Family Experience

PCMH 6B Factor 1: Access

Sample questions:

– When you called to schedule this appointment, did you get an appointment as soon as you thought you needed one?

– In general, how often do you feel that you are able to get an appointment as soon as you think you need one?

Patient Experience:

Communication

Sample questions:

– Did you have all of your concerns addressed and questions answered today?

– Did the nurse/provider communicate information about your health, medications and next steps in a way that was easy for you to understand?

Patient Experience: Coordination of Care

Sample questions: – How often does your primary care physician seem

informed and up-to-date about the care you got from a specialist?

– In the past year, did you and anyone in this provider’s office talk at each visit about all the prescription medicines you were taking?

Patient Experience: Self-Management Support

Sample Questions: – In the past year, did you and anyone in this

provider’s office talk about things in your life that worry you or cause stress?

– In the past year, did anyone in this provider’s office ask you if there are things that make it hard for you to take care of your health?

PCMH 6B Factor 2

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

• Developed by the Agency for Healthcare Research and Quality (AHRQ)

• Practices can receive special acknowledgement from NCQA for administering the PCMH version of the CAHPS Clinical Group Survey Tool: • Use specific method or vendor for collecting the

data • Report results to NCQA

PCMH 6B Factor 3

PCMH 6B Factor 4

PCMH 6B: Activity

Goal: Think about patient experience from the patient’s perspective

1. Remember a time when you, as a patient, experienced something positive or negative related to one or more of the four patient experience categories (access, communication, coordination, self-management).

2. Write down what questions you could ask on a patient experience survey that will let the health center staff know that they are doing well or poorly in that area.

PCMH 6C Implement Continuous QI

PCMH 6C Implement Continuous QI

What are the performance measures from A&B?

PCMH 6C Implement Continuous QI

NCQA Supplemental Worksheet: Documentation for Factors 1-3

Example documentation for factor 1. Meeting Notes For QI reporting

PCMH 6C Implement Continuous QI

PCMH 6D Demonstrate Continuous QI

PCMH 6D Demonstrate Continuous QI

PCMH 6D Demonstrate Continuous QI

PCMH 6E Report Performance

PCMH 6E Report Performance

Sample Documentation for 6B

Patient Experience Data collected internally. This origination had 5 clinics where PE results where entered monthly and distributed quarterly to the clinics

PCMH 6F Report Data Externally

Core Measures for all EP's Medicaid and Medicare

Measure Recommended Measure Title Recommended Measure Description

0013 AMA Hypertension: Blood Pressure Measurement

Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded.

0028a AMA Preventive Care and Screening Measure Pair: a.Tobacco Use

Assessment

Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months.

0028b AMA Preventive Care and Screening Measure Pair: b.Tobacco

Cessation Intervention

Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who received cessation intervention.

0421 QIP Adult Weight Screening and Follow-Up

Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented.

Alternate Core for all EP's Medicaid and Medicare

0024 NCQA Weight Assessment and Counseling for Children and

Adolescents

The percentage of patients 2-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.

0038 NCQA Childhood immunization Status

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates.

0041 AMA Preventive Care and Screening: Influenza Immunization for

Patients ≥ 50 Years Old

Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

PCMH 6E Report Data Externally Factor 1/CMS

PCMH 6E Report Data Externally

…taken from the CMS Attestation User Guide

PCMH 6E Report Data Externally