How to become recognized as a PCMH?

What is a Patient Centered Medical Home?

The Patient Centered Medical Home is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

The objective is to have a centralized setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

WHY PCMH? Why Do it?

The patient-centered medical home (PCMH) model is becoming widely acknowledged as a key to health care reform. Today, more than 7,600 practitioners at more than 1,500 locations across the country have achieved PCMH recognition through the National Committee for Quality Assurance (NCQA)—and that program is just one of four national PCMH recognition programs. So why take the plunge? Below are eight reasons to consider implementing the PCMH model in your organization.

1.    National Recognition

2.    Increased Market Competitiveness

3.    Potential Increased Reimbursement

4.    Aligns with the Affordable Care Act (ACA) Legislation

5.    Added Structure for CHC Expansion

6.    Parallels and Complements Meaningful Use

7.    Aligns with new and existing pilots / demonstration projects

8.    Positions for Accountable Care Organizations (ACOs) under the Affordable Care Act (ACA)

Quantifying the Potential Increased Reimbursement

PCMH is entirely voluntary and providers who participate can earn meaningful reimbursement increases of three types depending on the payer type:

·       On an average 12 percentage point increase added to current fee schedule

·       New fees for developing care plans for select patients with certain chronic or multiple conditions that put them at risk and for monitoring progress against those plans

·       Additional fee schedule increases (up to an 80 point increase) based on providers’ engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs.

PCMH Accreditation: 

For organizations wishing to seek recognition as a patient-centered medical home (PCMH), there are currently several programs that offer PCMH accreditation/recognition. Follow the links below each program for program details and specifications.

1.    National Committee for Quality Assurance (NCQA) 2011: http://www.ncqa.org/tabid/631/Default.aspx

2.    Joint Commission PCMH 2011: http://www.jointcommission.org/accreditation/pchi.aspx

3.    Accreditation Association for Ambulatory Health Care (AAAHC) 2011:http://www.aaahc.org/eweb/dynamicpage.aspx?webcode=mha

4.    URAC Patient Centered Health Care Home 2011: https://www.urac.org/healthcare/pchch/index.aspx

The Medical Group Management Association (MGMA) offers a free tool to help organizations that are considering becoming a PCMH compare the various accreditation programs. The tool summarizes how each program incorporates the Guidelines for Patient-Centered Medical Home Recognition and Accreditation Programs, developed in 2011 by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA.) To download the free tool, visit http://www.mgma.com/Books/Patient-Centered-Medical-Home-Guidelines/.

Blog Author's note:

The process of transforming into a PCMH is no minor change; it requires a total redesign of the care delivery process. Practices pursuing PCMH recognition must implement workflow changes and put in place new policies and processes to adhere with PCMH standards. With so many regulatory compliance issues to juggle, including Meaningful Use, ePrescribing and the Physician Quality Reporting System, how is your organization to find the time for PCMH transformation? If you, like so many other physicians today, are feeling overwhelmed, don't go it alone. Seek help from a technology consultant who is experienced in implementing the workflows and processes necessary to achieve medical home recognition.

e2o Health (http://www.e2ohealth.com) can help clinics become Patient Centered Medical Homes. Our expert clinical consultants can guide practices with the PCMH recognition process. Please contact us at (800) 326-0215 x 102 or email us at ssaran@e2ohealth.com for more information.

- Sunny Saran

Article Sources: We used the following sources to write this blog.
1. ACPOnline.org
2. SuccessEHS.com
3. MGMA.org