ncqa standards workshop physician practice connections - patient-centered medical home (ppc ®...
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NCQA Standards WorkshopPhysician Practice Connections - Patient-Centered Medical
Home (PPC®-PCMH™)
2009
2Physician Practice Connections─Patient-Centered Medical Home
Standards Workshop 2009
Agenda
• Patient-Centered Medical Home Overview
• Content of PPC-PCMH– Standards– Documentation examples*
• Recognition Process * Examples in the presentation only illustrate the
element intent. They are NOT definitive nor the only methods of documenting how the elements may be met
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The Patient-Centered Medical Home DefinedACP, AAFP, AAP, AOA Joint Principles – April 2007
• Personal physician – each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
• Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
• Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
• Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). 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.
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PPC-PCMH Content and ScoringStandard 1: Access and Communication
A. Access and communication processes**B. Access and communication results**
Pts
45
9
Standard 2: Patient Tracking and Registry Functions
A. Basic system for managing patient data B. Electronic system for clinical dataC. Use of electronic clinical dataD. Organizing clinical data**E. Identifying important conditions**F. Use of system for population management
Pts
233643
21
Standard 3: Care Management
A. Guidelines for important conditions **B. Preventive service clinician remindersC. Practice organizationD. Care management for important conditions E. Continuity of care
Pts
34355
20
Standard 4: Patient Self-Management Support
A. Documenting communication needsB. Self-management support**
Pts
24
6
Standard 5: Electronic Prescribing
A. Electronic prescription writing B. Prescribing decision support - safetyC. Prescribing decision support - efficiency
Pts
332
8
Standard 6: Test Tracking
A. Test tracking and follow up** B. Electronic system for managing tests
Pts
76
13
Standard 7: Referral Tracking
A. Referral tracking**
Pts
4
4
Standard 8: Performance Reporting and Improvement
A. Measures of performance ** B. Patient experience dataC. Reporting to physicians **D. Setting goals and taking action E. Reporting standardized measures F. Electronic reporting to external entities
Pts
333321
15
Standard 9: Advanced Electronic Communications
A. Availability of interactive website B. Electronic patient identification C. Electronic care management support
Pts
121
4
**Must Pass Elements
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PPC-PCMH Scoring
Level of Qualifying
PointsMust Pass Elementsat 50% Performance
Level
Level 3 75 - 100 10 of 10
Level 2 50 – 74 10 of 10
Level 1 25 – 49 5 of 10
Not Recognized
0 – 24 < 5
Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will achieve at Level 1.
Practices with a numeric score of 0 to 24 points or less than 5 Must Pass Elements are not Recognized.
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PCMH Must Pass Elements1. PPC1A: Written standards for patient access and patient
communication
2. PPC1B: Use of data to show meeting this standard
3. PPC2D: Use of paper or electronic-based charting tools to organize clinical information
4. PPC2E: Use of data to identify important diagnoses and conditions in practice
5. PPC3A: Adoption and implementation of evidence-based guidelines for three conditions
6. PPC4B: Active support of patient self-management
7. PPC6A: Tracking system for tests and to identify abnormal results
8. PPC7A: Tracking referrals with paper-based or electronic system
9. PPC8A: Measurement of clinical and/or service performance
10. PPC8C: Performance reporting by physician or across the practice
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Data Sources & Health Information Technology (HIT) Guidance
• Elements may have multiple suggestions for data sources and documentation– select what your practice would use to demonstrate that function and describe how it is used
• Each element indicates the type of health information technology needed to perform the functions – Basic – (HIT) Basic
• Paper-based or basic (mostly administrative) electronic system
– Intermediate – (HIT) Intermediate• Electronic system for clinical functions
– Advanced – (HIT) Advanced• Electronic system with connectivity or interoperability with
other systems
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PCMH Elements by Type of Information Technology (IT)
Basic Intermediate
Advanced
PPC 1 A - B PPC 2 B, C, F PPC 6 B
PPC 2 A, D, E PPC 5 A - C PPC 8 F
PPC 3 A - E PPC 8 E
PPC 4 A - B PPC 9 A - C
PPC 6 A
PPC 7 A
PPC 8 A - D
TOTAL = 18 TOTAL = 10 TOTAL = 2Practice can achieve a passing score on Must Pass Elements with Basic Information Technology
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PPC1 - Access and Communication
Patient access to care and communication
• PPC1A: Access and communication processes
• PPC1B: Access and communication results
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PPC 1 Element A: Access and communication processes
Practice has written process for*:– Scheduling patients with
same clinician– Coordinating visits with
multiple clinicians during one trip
– Determining how soon a patient needs to be seen
– Responding to urgent calls within specified time
– Providing telephone advice
– Providing language services
*Shows 6 of 12 items in Element A
Must Pass - 4 points• Scoring: based on 12
items– 9-12 items = 100%– 7-8 items = 75%– 4-6 items = 50%– 2-3 items = 25%– 0-1 item = 0%
• Documentation:– Written process– Policies and
procedures– Instructions – Appointment system
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PPC1A: Scheduling Policy
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PPC 1 Element B: Access and communication results
• Practice shows how it meets patient access and communication standards– Visits with assigned
physician– Appointments
scheduled to accommodate patient condition and need
– Timely response to phone, e-mail and Internet requests
– Language services if the practice’s population requires it
Must Pass - 5 points• Scoring: Based on
number of items met of 5– 5 items = 100%– 4 items = 75%– 3 items = 50%– 2 items = 25%– 0-1 item = 0%
• Data source: – Reports– Logs or screen shots
showing records of appts. scheduled and time for returning calls
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Access Standards with Specific Targets and Result Measurements
Standards
Results Measurements
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PPC2 - Patient Tracking and Registry Functions
Systematic use of patient information for population management to support patient care
• PPC2A: Basic System for Managing Patient Care
• PPC2B: Electronic System for Clinical Data• PPC2C: Use of Electronic Clinical Data• PPC2D: Organizing Clinical Data• PPC2E: Identifying Important Conditions• PPC2F: Use of System for Population
Management
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PPC2A: Basic System for Managing Patient Data
Practice uses electronic data system for searchable patient information 1-9. Name, DOB, gender,
marital status, language preference, race/ethnicity, address, phone, email
10-11. Internal and external IDs
12. Emergency contact info.13. Current and past
diagnoses14. Dates of prior visits15. Billing code16. Legal guardian17. Health insurance coverage18. Preferred method of
communication
2 points • Scoring: Number of
items met of 18– 12-18 items = 100% – 8-11 items = 75% – 6-7 items = 50% – 4-5 items = 25%– 0-3 items = 0%
• Data source: – Reports from
electronic system showing data items entered for 75-100% of patients
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Element A- Report Showing Basic Patient Information Field Use
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PPC2B: Electronic System for Clinical Data
Practice uses clinical data systems to manage care of patients has searchable data fields for clinical patient information: 1. Preventive services2. Allergies/adverse
reactions3. Blood pressure4-5. Height and Weight6. BMI7-9. Lab test, imaging and
pathology results10.Advance directives11.Head circumference (for
patients ≤ 2 years
3 points• Scoring: Number of
items met of 10– 9-10 items = 100% – 7-8 items = 75% – 5-6 items = 50% – 3-4 items = 25%– 0-2 items = 0%
• Data source: – Reports or screen
shots showing data fields in patient records
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Example PPC2B: Screen Shot of Data Fields for Clinical Data
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PPC2C: Use of Electronic Clinical Data Practice uses the fields listed in 2B consistently in patient records 1. Preventive services2. Allergies3. Blood pressure4-5. Height and Weight6. BMI7-9. Lab test, imaging
and pathology results
10. Advance directives
3 points• Scoring: Practice enters
a percentage of patients seen in past 3 months with 7 fields completed:– 75-100% of patients =
100% – 50-74% of patients = 75%– 25 -49% of patients = 50%– 10-24% of patients = 25%– <10% of patients = 0%
• Data source: – Reports from electronic
system OR– Record Review Workbook
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Element C: Report of percent of patients with clinical data items entered in system
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What is the Record Review Workbook?
• Elements PPC 2C, 2D, 3D, 4B • Require medical record abstraction of data• Need % of patients based on numerator and
denominator
• Two methods to collect and submit patient data
– Method #1 - report from the electronic system– Method #2 – Record Review Workbook
• Excel workbook in the Survey Tool• Tool to identify sample of patients and abstract data
needed for Elements 2C, 2D, 3D, 4B
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Example PPC 2C, 2D, 3D, 4B Option NCQA Medical Record Review Worksheet
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Selecting Patients for Record Review Workbook
~Use same 36 patients for EACH Workbook Element~
STEP #1. START DATE = Today’s date June 1
STEP #2. Go back 30 days = May 1
STEP #3. • Use appointment or billing system to identify patients with visit on April 30• Choose patients with any of three clinically important conditions who had a visit on this date related to the conditions
STEP #4. Continue choosing patients going back on consecutive dates until all 36 patients are selected
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PPC2D: Organizing Clinical Data• Practice uses paper or
electronic charting tools used to organize and document clinical information1. Problem lists2. Medication lists (OTC)3. Medication lists (RX)4. Template for risk
factors5. Templates for
progress notes6. Screening for
developmental testing7. Growth charts & BMI
• Based on number of items documented in records of patients seen in last 3 months
Must Pass – 6 points• Scoring - % of patients with
3 tools documented: – 75-100% = 100%– 50-74% = 75%– 25-49% = 50%– 10-24% = 25%– <10% = 0%
• Data source– Record Review Workbook or– Electronic system report
with percent of patients seen in past 3 months
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PPC 2D - what to look for in the medical record:
Documented Risk Factors And Medication Lists In Paper Flow Sheet
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PPC2D: Pediatric Weight Chart
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PPC2E: Identifying Important Conditions
• Practice identifies1. Most frequently seen
diagnoses = most often seen, single episode or chronic; identify by number of patients, visits, total fees billed
2. Most important risk factors = for the demographic population
3. Three clinically important conditions (chronic or recurring) = practice identifies
Must Pass – 4 points• Scoring
– 3 items = 100%– 2 items = 75%– 1 item = 50%– 0 items = 0%
• Data source– Reports from EHR,
practice management system, billing or scheduling system for frequent Dx
– Identify risk factors in reports
– Identify conditions and why selected in the Support Text/Notes section
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PPC2E: Example Text Notes in Survey Tool
“Attached are 3 reports:
1. Frequent diagnoses: Dates of service and the diagnosis codes, sorted by codes for frequency.
2. Risk factors: Source of Community Statistics for Risk Factors - www.CDC.gov and http://apps.nccd.cdc.gov/brfss/display_PF.asp
3. Clinically important conditions: As part of a National PCMH Demonstration Project, the Demonstration Project Stakeholders have chosen Diabetes, Hypertension and Hyperlipidemia which represent the best likelihood of being amenable to care management and providing value on costs to the health care system based on regional experience.”
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PPC2F: Use of System for Population Management
Practice uses electronic information to generate lists of patients and remind patients and clinicians proactively of services needed:1. Pre-visit planning2. Clinician action3. Specific medications4. Preventive care5. Specific tests6. Follow-up visits7. Care management
services
3 points• Scoring: Practice takes
action on – 5-7 items = 100% – 3-4 items = 75%– 1-2 items = 50%– 0 items = 0%– Practice gets partial credit If
system can generate lists but practice does not use it
• Two Data sources: 1. Lists generated -- reports
from EHR, registry and 2. Example of use of the
lists -- screen shots, written description of process
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Population Management ExamplesEHR Query-Patients Needing
Pneunomax vaccine Report – Patients on a Specific Medication
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PPC3: Care Management
Practice maintains continuous relationship with patients by using evidence-based guidelines and applying them to needs of individual patients over time.
• PPC3A: Guidelines for Important Conditions • PPC3B: Preventive Service Clinician Reminders• PPC3C: Practice Organization• PPC3D: Care Management for Important
Conditions • PPC3E: Continuity of Care
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PPC3A: Guidelines for Important Conditions
• Practice adopts and implements evidence-based diagnosis and treatment guidelines for three clinically important conditions
• Use same conditions in PPC2D, 2E, 3A, 3D, 4B, 9C
Must Pass – 3 points• Scoring
– 3 conditions = 100%– 2 conditions = 50%– 1 condition = 25%– 0 conditions = 0%
• Data source: workflow organizers that show guidelines adopted and implemented– Provide source of guidelines– Paper flow sheets,
templates for documenting progress
– Screen shots showing templates for treatment plans and documenting progress
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Example PPC3A – Adoption of Evidence –Based Diagnosis and Treatment
Guidelines
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Example – Evidence-Based Diabetic Workflow
Organizer (shows what to document at each visit)
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Example PPC3A - EHR Prompting Lipid Management Evidence-Based Guidelines
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PPC3B: Preventive Service Clinician Reminders
• Practice generates reminders about preventive services for clinicians
• Practice uses paper or electronic guideline-based alerts and reminders to write orders and conduct assessments 1. Screening tests2. Immunizations3. Risk assessments4. Counseling
4 points• Scoring
– Reminders for 4 items = 100%
– Reminders for 3 items = 75%
– Reminders for 2 items = 50%
– Reminders for 1item = 25%– Reminders for no items =
0%• Data source: reports,
screen shots, templates or paper flow sheets showing decision- support for clinicians during visits, calls and email.
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Example PPC3B - Preventive Service
Reminders for Clinicians Paper Reminder for Risk
Assessments, Immunizations, Screening Tests
EHR with Risk Assessment Reminders
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PPC3C: Practice Organization• Care team manages
patient care:1. Non-physician staff remind
patients of appointments and collect information before appointments
2. Non-physician staff execute standing orders (e.g. med. refills, order tests)
3. Non-physician staff educate patients to manage conditions
4. Non-physician staff coordinate care with external disease management or case management organizations
3 points• Scoring
– 4 items = 100%– 3 items = 75% – 2 items = 50% – 0-1 item = 0%
• Data source– Job descriptions– Protocols– Written standing
orders
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Example PPC3C: Practice Organization Standing Orders
Note: If patient needs OV or labs, refill up to one month (one time only). If more requested, check with physician
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PPC3D: Care Management for Important Conditions
To manage care of patients with three clinically important conditions, practice uses:
1. Pre-visit planning
2. Individualized written care plans
3. Individualized treatment goals
4. Assess progress toward goal
5. Review of medications with patients
6. Review self-monitoring results and include in medical record
7. Assess barriers when patient not met treatment goals
8. Assess barriers when patient not filled prescriptions or took meds.
9. Follow-up when patient not kept important appointments
10. Review patient clinical data over time
11. After-visit follow-up
5 points• Scoring – patients seen
in past 3 months have 4 items documented:– ≥75% of patients =
100%– 50-74% of patients =
75%– 25-49% of patients =
50%– 11-24% of patients =
25%– ≤10% of patients = 0%
• Data source – Report from electronic
system showing percent of patients seen with documentation of items OR
– Record Review Workbook
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PPC3D: Written Care Plan in Medical Record
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Patient Progress, Treatment Goals and Medication Review
Patient Progress and Treatment Goals
Treatment plan and goals
Patient progress
PPC 3D - what to look for in the medical record: Documented Patient Progress and Treatment Goals
Medication Review
Assessment & Plan
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PPC3E: Continuity of CarePractice provides continuity of care for patients who receive care in inpatient or outpatient facilities1. Identifies patients 2. Sends information to facilities and
patients3. Reviews information from facilities
to identify patients needing proactive contact or are at risk for adverse outcomes
4. Contacts patients post-discharge5. Provides or coordinates follow-up
care to discharged patients6. Coordinates care with external
disease or care management organizations
7. Communicates with patients getting disease or high risk case management
8. Communicates with case managers for patients getting disease or high risk case management
9. Develops written transition plan with patient for transition to other care
10.Coordinates with new physicians
5 points• Scoring
– 5-10 items = 100%– 3-4 items = 75%– 2 items = 50%– 0-1 item = 0%
• Data source: from practice or external organization– Protocols re: timeline
for patient follow-up– Protocols for care plans– Log of patients
receiving care from other facilities
– Registry, EHR, hospital or ER reports
– Health needs assessments
– Blinded case management or medical record notes
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Example – ER Visit Follow-Up Log
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Example – Follow-Up Care after Hospital Admission
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PPC4 - Patient Self-Management Support
Improve patient ability for self-management by:
• PPC 4A - Documenting communication needs
• PPC 4B - Providing self-management support
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PPC4A: Documenting Communication Needs
Practice assesses patient-specific barriers to communication using systematic process to:1. Identify and display
in record patient language preference
2. Assess both hearing and vision barriers
2 Points
• Scoring:– 2 items = 100%
– 1 item = 50%
– 0 items = 0%
• Data source - How practice– Records language
preference: screen shots, patient assessment forms
– Determines % of patients preferring another language: reports from EHR, patient record review
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PPC4A: Example Documenting Communication Needs
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PPC4B: Self-Management Support • Practice documents
patient self-management support for 3 clinically important conditions1. Assess patient
preferences, readiness and ability for self-management
2. Provides educational resources in patient language
3. Provides self-monitoring tools for patients
4-6. Provides or connects patient with support programs, classes, resources
7. Provides patient with written care plan
Must Pass – 4 points• Scoring – % of patients
seen in past 3 months have 3 items documented:– 75-100% patients = 100%– 50-74% = 75%– 25-49% = 50%– 11-24% = 25%– ≤10% = 0%
• Data source – Record Review Workbook
or– Report from electronic
system
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PPC 4B - what to look for in the medical record: Documented Use of Self-Monitoring Tools &
Program Referrals
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PPC5: Electronic PrescribingPractices uses electronic systems to order
prescriptions, to check for safety and to promote efficiency when prescribing.
• PPC5A: Electronic Prescription Writing • PPC5B: Prescribing Decision Support –
Safety• PPC5C: Prescribing Decision Support –
Efficiency
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PPC5A: Electronic Prescription Writing
Practice uses an electronic system to write prescriptions1. Stand-alone system
(i.e., hand-held e-prescribing device, PDA)
2. System that links data to specific patients (i.e., EHR)
3 points• Scoring
– 75-100% of prescriptions for patients seen in past 3 months written with item 2 = 100%
– 75-100% of prescriptions for patients seen in past 3 months written with item 1 = 75%
– System capable of either item 1 or 2 but practice does not use or cannot report %= 25%
– No system capability or <75% of item 1 or 2 = 0%
• Data source: – Reports showing practice
used system for writing prescriptions for 75-100% of patients within past 3 months
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PPC5A: Example Prescribing Method
EXPLANATION
January to March 2009 prescribing method is documented in the table. Certain prescriptions (Schedule II) must be printed on special paper prescription pads in our state. 96% of prescriptions were generated from our electronic medical record.
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Example PPC 5A - % of Use for Electronic Prescriptions
Evaluation:Our Physicians and nurses put all prescriptions in our EMR which is
linked to patient -specific demographic and clinical data. Note the screen shot that denotes the number of scripts for our
physicians in the last three months, 2046 and the report which notes the number of patients seen during that same time period, 2482.
We propose that this represents a percentage between 75% and 100%, understanding that one prescription does not mean one patient.
2046 prescriptions provides the numerator to determine the percentage. The practice provided another report showing the summary of the 2482 patients seen during the same period to provide the denominator
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PPC5B: Prescribing Decision Support – Safety
Electronic prescription reference information at the point of care including alerts and information: 1-2. drug-drug interactions -
general and patient-specific 3-4. drug-disease interactions –
general and patient-specific5-6. Drug-allergy alerts -
general and patient-specific7. Drug-patient history alerts8-9. Appropriate dosing –
general and patient specific10. Drug-lab alerts – general 11-12. Duplication of drugs –
general and patient-specific13-14. Drugs to be avoided in
elderly15. Patient-appropriate
medication information
3 points• Scoring
– Practice uses ≥8 alerts and information = 100%
– Practice uses 4-7 alerts and information = 75%
– Practice uses 2-3 alerts = 50%
– System has >6 alerts but not used = 25%
– No system capability or <6 alerts or practice uses <2 alerts
• Data source: – Reports from system,
showing example of each item
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Example PPC5B - EHR Prescription Allergy Pop Up Box (safety check)
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PPC5C: Prescribing Decision Support – Efficiency
Cost-efficient electronic prescription writer with: 1. Automatic alerts
for drug choices, including generics
2. Payer-specific formulary that alerts clinician to alternative drugs, including generics
2 points• Scoring
– Practice uses 2 tools = 100%
– Practice uses 1 tool = 75%
– System has both tools but practice doesn’t use it = 25%
– System lacks capability or practice does not use either tool = 0%
• Data source– Reports – Screen shots– Practice protocols
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PPC5C: Prescribing Decision Support – Efficiency
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PPC6 - Test Tracking
Practice systematically tracks tests ordered and test results, and systematically follows up with patients.
• PPC 6A - Test tracking and follow-up• Basic – if paper system• Intermediate – if electronic communication
within the practice office• Advanced – if electronic communication
between practice and lab and imaging facilities
• PPC 6B - Electronic system for managing tests
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PPC6A: Test Tracking and Follow-up
Practice uses paper or electronic system to track tests and follow up 1. Tracks lab tests until
results return to practice and flag overdue results
2. Tracks imaging tests until results return to practice and flag overdue results
3. Flag abnormal test results
4. Notify patients of abnormal results
5. Follows up with inpatient facility on hearing and metabolic screening
6. Notifies patients of normal results
Must Pass – 7 points• Scoring
– 4-6 items = 100%– 3 items = 50%– System can do 4 types of
tracking but isn’t in use = 25%
– System can’t track or practice uses <3 types of tracking and follow-up = 0%
• Data source: – Evidence that practice
reviews and uses tracking log before or at beginning of patient visits
– Reports or tracking logs or e-mail inbox flagging results
• Filing results in the medical record until patient comes in does not meet tracking and follow-up standard
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Example PPC6A - Lab Tracking Manual Log Spreadsheet
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PPC6A: Example Notifies Patient of Abnormal Results
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PPC6B: Electronic System for Managing Tests
• Electronic system to1-2. Order lab and imaging
tests 3. Retrieve results from
source 4-5.Retrieve imaging text
and images from source 6. Route and manage
current and historical test results to appropriate personnel for review
7. Flag duplicate tests8. Generate alerts for
appropriateness• Assumes electronic
communication between practice and lab and imaging facilities
6 points• Scoring
– 5-8 functions = 100%– 3-4 functions = 75%– 1- 2 functions = 50%– Doesn’t use system = 0%
• Data source– Reports or screen shots
showing examples of required functions
– Filing results in the medical record until patient comes in does not suffice for tracking and follow-up
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Example PPC6B - EHR Order ScreensLaboratory Test Order Screen Radiology Test Order Screen
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PPC7 - Referral Tracking
PPC 7A - Document and track referrals
and referral results
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Example PPC7A - Manual Consultant Tracking Logs
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PPC7A: Example Referral Results
REFERRAL RESULTS Caregiver Patient Dates Status (Reviewed) Type (Referrals) Patient/Procedure Date Ordered
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PPC8: Performance Reporting and Improvement
Practice regularly measures its performance and takes actions to continuously improve
• PPC8A: Measures of Performance• PPC8B: Patient Experience Data• PPC8C: Reporting to Physicians • PPC8D: Setting Goals and Taking Action• PPC8E: Reporting Standardized Measures • PPC8F: Electronic Reporting ─ External
Entities
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PPC8A: Measures of Performance• Practice measures
or receives clinical and/or service performance data 1. Clinical process2. Clinical outcomes3. Service data4. Patient safety issues
• Reports may be generated by the practice, an affiliated medical group or health plan
• Credit given for NCQA Recognition for items 1 and 2
Must Pass – 3 points
• Scoring – performance measurement:– 2 types = 100%– 1 type = 50%– No measures = 0%
• Data source - Reports from – Manual review of sample
of patient records– Patient surveys– Practice management
system– Registry– Data from health plan or
larger medical group– Electronic database
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NCQA Clinical Program RecognitionWhere Can it Be Used to Meet Element?
• NCQA Clinical Recognition Programs– Diabetes Recognition Program (DRP)– Heart/Stroke Recognition Program (HSRP)– Back Pain Recognition Program (BPRP)
• Credit for Clinical Program Recognition may be used for meeting requirements in 7 elements if majority of physicians are Recognized: – PPC 3A, 3D (for selected conditions used for
survey)– PPC 8A, 8C, 8D, 8E, 8F
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Example PPC8A – Plan and Network Level Reports
CAHP’s Patient Satisfaction Report Clinical Performance Report
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PPC8B: Patient Experience Data
Practice collects data on patient experience with are: 1. Patient access to care 2. Quality of physician
communication3. Patient confidence in
self-care 4. Patient satisfaction
with care
3 points• Scoring – practice
collects data on – 3-4 areas = 100%– 1-2 areas = 50%– 0 areas = 0%
• Data source: – Reports of paper,
telephone, or electronic survey
– Practice must provide summarized data, not a blank survey
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PPC8B: Patient Experience Data
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PPC8C: Reporting to Physicians
Practice reports performance on measures in PPC8A 1. Across the practice
2. By individual physician
Must Pass – 3 points
• Scoring - practice reports:– Across practice and by
physician = 100%
– Either across practice or by physician = 50%
– No reporting = 0%
• Data source: – Blinded reports with
performance data
– Blinded letters to physicians with performance data
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Example of B – Reporting Across the Practice and Across Multiple Practice Sites
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PPC8D: Setting Goals and Taking Action
Practice uses performance data to1. Set goals based
on performance data in PPC8A and 8B
2. Takes action to improve performance of individual physicians or practice
3 points• Scoring
– 2 items = 100%– 1 items = 50%– 0 items = 0%
• Data source: – Practice-specific
reports or
– Completion of NCQA’s Quality Improvement Workbook
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Example PPC8D – NCQA’s QI Worksheet Documenting Setting Goals And Taking Action
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PPC8E: Reporting Standardized Measures
Practice produces reports on performance using nationally approved clinical performance measures– National Quality Forum
endorsed physician level measures
2 points• Scoring based on
number of measures the practice reports– ≥10 items = 100%– 5-9 items = 75%– 3-4 items = 50%– 0-2 items = 0%
• Data source: – Reports showing
performance measures calculated by practice
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Example PPC8E - National Quality Forum Endorsed Physician Level Measures
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PP8F: Electronic ReportingExternal Entities
• Practice electronically reports results on nationally approved measures to external entities
• Practice gets partial credit if its system has the capability to report data but does not use it
1 point• Scoring based on
number of measures practice reports– ≥10 measure = 100%– 5-9 measures = 75%– 3-4 measures = 50%– 1-2 measures = 25%– 0 measures = 0%
• Data source: – Report to public sector,
health plans or others
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PP8F: Example Electronic ReportingExternal Entities
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PPC9: Advanced Electronic Communication
Practice uses electronic communication to improve timeliness, effectiveness, efficiency and coordination of care.
• PPC9A: Availability of Interactive Web Site
• PPC9B: Electronic Patient Identification
• PPC9C: Electronic Care Management Support
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PPC9A: Availability of Interactive Web Site
Patient has access to Interactive Web site to: 1. Request
appointments2. Request referrals 3. Request test results4. Prescription refills5. See medical record6. Import medical data
to personal records
1 point• Scoring – practice
provides– 5-6 items = 100%– 3-4 items = 75%– 1-2 items = 50%– 0 items = 0%
• Data Source: screen shots showing Web functionality
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PPC9A: Example Interactive Website Factor 2, Requesting Appointment
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PPC9B: Electronic Patient Identification
Electronic information and clinical decision-support to contact patients by email needing:1. Clinical review or action2. On a particular
medication3. Preventive care4. Special tests5. Follow-up visits6. Disease/case
management support
2 points• Scoring
– 5-6 items = 100%– 3-4 items = 75%– 1-2 items = 50%– 0-1 items = 0%
• Data source– Screen shots showing
identification of patients and example of e-mail
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PPC9B: Example Electronically Contacting Patient to Review Test
Results
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PPC9C: Electronic Care Management Support
Electronic care management support for three clinically important conditions to1. Communicate with
disease/care managers about patient needs
2. Provide Web-based educational modules for patient self-management
1 point• Scoring
– 4 items = 100%– 3 items = 50%– 2 items = 25%– 0-1 items = 0%
• Data source– Screen shots showing
electronic communication about care management
– Screen shots or links to educational modules
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PPC 9C: Example Electronic Care Management Support
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Example PPC 9C: Diabetes Education Web-sites for Patient Self-Management
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What is the PPC-PCMH application and survey process?
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Recognition Process• Practices may use the Survey Tool to self-
assess before submitting to NCQA
• Recognition is based on:– Responses in Web-based Survey Tool– Supporting documentation attached to Survey Tool
• Element specifies type of documentation – Reports
• Reports from EHR, registry, practice management & billing systems
– Documentation of processes • Policies and procedures, protocols
– Records or files • NCQA’s Medical Record Review Workbook• Screen shots from EHR
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Who is Recognized?
• NCQA Recognizes practices that meet the criteria described by the endorsed principles of the Patient-Centered Medical Home
• NCQA defines a practice as a physician or physicians practicing together at a single geographic location
• Recognition is at the practice-site level
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NCQA’s Interactive Survey System
(ISS)
• ISS is a Web-based application program
• The practice uses ISS (Survey Tool) for:– Entering responses to each
factor for each element – Attaching documents and
providing text to support the responses
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Steps for the Physician/Practice1. Review program information
2. Participate in a standards workshop (See www.ncqa.org/rptraining.aspx)
3. Obtain a Survey Tool
4. Participate in a WebEx ISS demonstration of the Survey Tool
5. Use Survey Tool to self-assess current performance
6. Submit completed application, agreements, fee, and results to NCQA when ready
7. Receive final Recognition decision and Level in 30 – 60 days
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PPC-PCMH Survey Process1. NCQA receives Survey Tool
2. NCQA evaluates Survey Tool• Responses, documentation, and explanations• Practice may be contacted for clarifications
3. On-site audit - 5% of practices
4. Final decision and status determined
5. Report results with Level 1, 2, or 3 • Recognition posted on NCQA Web site• Not passed - not reported
6. PPC-PCMH certificate and recognition packet
7. Practice achieving Level 1 or 2 can do add-on survey within the 3 year recognition time period
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Results: Impact of Program
• Better chronic-care management programs
• Greater attention to patient compliance• Improved patient outreach
– Patient reminders, increased screenings – Educational materials
• Increased data collection and reporting• Significant adoption and use of patient
registriesMeasurement + Rewards = Improvement!
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NCQA Contact Information
Contact NCQA Customer Support to:• Acquire standards documents, application materials,
and survey tools• Questions about your user ID, password, access• 1-888-275-7585
Visit NCQA Web Site to:• View Frequently Asked Questions• View Recognition Programs Training Schedule
Submit to questions to [email protected] Please use this e-mail box to:• Ask about interpretation of standards or elements• Submit application materials (physician workbook and
application)• Request registration for ISS Survey Tool demonstration (Web-ex)
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PPC-PCMH Program Sponsors