5Today’s Agenda Standard 1 – Enhance Access & Continuity PCMH1A: Access During Office Hours – MUST PASS (review from Webinar #2)PCMH1B: After-Hours AccessPCMH1C: Electronic AccessPCMH1D: ContinuityPCMH1E: Medical Home ResponsibilitiesPCMH1F: Culturally and Linguistically Appropriate ServicesPCMH1G: The Practice Team5
6PCMH 1A: Access During Office Hours Practice has written process/standards and demonstrates that it monitors performance against the standards to:Provide same-day appointments – CRITICAL FACTORProvide timely advice by telephoneProvide timely advice by electronic messageDocument clinical advice
7PCMH 1A: Access During Office Hours MUST PASS4 Points:4 factors= 100%3 factors (including factor 1) = 75%2 factors (including factor 1)= 50% (must-pass threshold)Factor 1= 25% (not sufficient for passing element)0 factors or missing factor 1 = 0%Data Sources:Documented process for scheduling appointments, providing clinical advice and documenting adviceReport showing same-day access, response timesScreen shots or copies of documented clinical advice
8PCMH 1A: Example – Factor 1 This is the practice’swritten policy onsame-day scheduling
9PCMH 1A: Example – Factor 1 (Your Practice Name)This is the practice’swritten policy onsame-day scheduling
11PCMH 1A: Example – Factor 2 Element 1A, Factor 2
12PCMH 1A: Example – Factor 2 Percent of calls returned on the same day
13PCMH 1B: After-Hours Access Practice has written process/standards and monitors performance:Provide access to routine and urgent-care outside business hoursProvide continuity of medical record information for care and advice when office is closedProvide timely advice by phone when office is closed – CRITICAL FACTORProvide timely advice using interactive electronic system when office is closedDocument after-hours advice
14PCMH 1B: After-Hours Access 4 Points:5 factors= 100%4 factors (including factor 3) = 75%3 factors (including factor 3)= 50%1-2 factors= 25%0 factors = 0%Data Sources:Documented process for arranging after hours access, making medical records available after hours, providing timely advice after hours, documenting advice after hoursReport showing after hours availability, response timesMaterials communicating practice hoursScreen shots or copies of documented clinical advice
15PCMH 1B: Example – Factor C POLICY - The designated lead physician or manager will prepare and maintain a schedule for members of the medical staff to provide on-call services. The schedule will provide for one physician to be on call for Lakeside Family Physicians and one physician for Lakeside Primary Care. Call will transfer to the designated physician at the end of primary care hours on the day listed on the schedule.PROCEDURE - Physician Procedure: The primary care physician assigned to on-call coverage will be available at all times and capable of responding by telephone within fifteen minutes. The on call physician will document on phone note the following information:Patient namePerson calling if other than the patientPhysician nameTime and date of callReason for callAdvice givenFollow up neededThis is an example of a practice’s policy on after-hours telephone call.
16PCMH 1C: Electronic Access Practice provides through a secure electronic system:Electronic copy of health information within 3 days to more than 50% of patients who request it**Electronic access to current health information within 4 days to at least 10% of patients**Clinical summaries provided for more than 50% of office visits within 3 days**Two-way communicationRequest for appointments or prescription refillsRequest for referrals or test results** Meaningful Use Requirement
17PCMH 1C: Electronic Access 2 Points:5-6 factors = 100%3-4 factors = 75%2 factors = 50%1 factor = 25%0 factors = 0%Data Sources:Report showing percentage of patients who received electronic copy of health information, access to requested health information, electronic clinical summariesScreen shots of its secure web site or portal, web page where patients can make requests and communication capability with patients
19PCMH 1C: Example – Factors 1, 2 this screenshot demonstrates online lab results
20PCMH 1C: Example – Factors 5 this screenshot demonstrates online scheduling system
21PCMH 1C: Example – Factor 5 this screenshot demonstrates online refill requests
22PCMH 1D: Continuity Practice provides continuity by: Expecting patients to select a personal clinicianDocumenting the choice of clinicianMonitoring percent of patient visits with clinician
23PCMH 1D: Continuity 2 Points: Data Sources: 3 factors = 100% Documented process or materials for clinician selectionScreen shot showing patients choice of clinicianReport showing patient encounters with clinician
24PCMH 1D: Example – Factor 3 “Assigned Visits” = patients who are assigned to that PCP“Unassigned Visits” = patients who are not assigned to that PCP
26PCMH 1E: Medical Home Responsibilities Practice has process and provides materials about role of medical home:Practice responsible for coordinating patient careHow to obtain care/advice during/after office hoursPatients provide complete medical history and information on care obtained outside practiceCare team gives patient access to evidence-based care and self-management support
27PCMH 1E: Medical Home Responsibilities 2 Points:4 factors = 100%3 factors = 75%2 factors = 50%1 factor = 25%0 factors = 0%Data Sources:Documented process for providing patient informationPatient materials
29PCMH 1E: Example – Factor 1 Patient Center Medical Home FACT SHEETWhat is a patient centered medical home? A patient centered medical home is a care team, led by a primary care physician that focuses on each patient’s health goals and needs, and coordinates that patient’s care across all settings. The concept of a medical home was initially introduced by the American Academy of Pediatrics in In March 2007, the AAP, the American College of Physicians , the American Academy of Family Physicians, and the American Osteopathic Association issued the Joint Principles of the Patient Centered Medical Home in response to several large national employers seeking to create a more effective and efficient model of health care delivery. Patient-Centered Medical Home is not an actual building, house or hospital. It’s a team approach to providing comprehensive health care in a high-quality and cost-effective manner.A Patient-Centered Medical Home is based on a continuous relationship with a personal physician. The physician leads a team of medical professionals who together take responsibility for a person’s care through all stages of life. The patient has one place to call; they have greater access to services; they get personalized care; that care is safe and scientifically valid; and there is a focus on preventive care which keeps costs down and patients healthier.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.
34PCMH 1E: Example – Factor 4 Patient Self management tools are available by clicking on the last tab in Provider Portal or by going to the “Patient Mgmt Tools” tab at the CCNC website:These tools are all non-branded, evidence based, low literacy appropriate and have been vetted by physicians at CCNC
38PCMH 1F: Culturally & Linguistically Appropriate Services Practice meets the cultural and linguistic needs of its patients:Assesses racial/ethnic diversity of patientsAssesses language needs of patientsProvides interpretation servicesProvides printed materials in patient language
39PCMH 1F: Culturally & Linguistically Appropriate Services 2 Points:4 factors = 100%3 factors = 75%2 factors = 50%1 factor = 25%0 factors = 0%Data Sources:Report showing assessment of racial/ethnic/language of patientsDocumentation showing use of interpretation serviceMaterials in other languages or website in other languages
46For non-English speakers, you also can print these instructions in 13 languages.
47CCNC Provider Portal To sign up, visit: https://portal.n3cn.org Reports are specific to NC Medicaid enrollees, but patient materials can be used/downloaded (for free) for any patientsTo sign up, visit:https://portal.n3cn.org
48PCMH 1G: Practice Team Practice provides patient care services by: Defining roles for clinical/nonclinical team membersHolding regular team meetings - CRITICAL FACTORUsing standing ordersTraining and assigning care team to coordinate careTraining on self-management, self-efficacy and behavior changeTraining on patient population managementTraining on communication skillsCare team involvement in performance evaluation and QI
49PCMH 1G: Practice Team 4 Points: Data Sources: 7-8 factors (including factor 2) = 100%5-6 factors (including factor 2) = 75%4 factors (including factor 2) = 50%2-3 factors = 25%0-1 factors = 0%Data Sources:Staff position descriptionsDescription of staff communication processesWritten standing ordersDescription of training process, schedule, materialsDescription of how staff is involved in practice improvements
51Next Steps (Homework) Review the requirements for Standard 1 What does the practice already do?What does the practice need to adopt/implement?Are there elements the practice clearly does not have in place and does not plan to have in place in time for submission?
52Next Steps (Homework) Organize Your Documents Create a place on your computer (server or hard-drive) for all of your documentationYou should have a folder for each standardA checklist can help you determine what you already have created/saved and what you need to prepare from scratch
53Next Steps (Homework)Go to NCQA’s website and take advantage of the various (free) training presentations they have available:2011 StandardsUsing the ISS Interactive Survey SystemSubmitting As a Multi-Site Practice
54Community Care PCMH Team David Halpern, MD, MPHCommunity Care of North Carolina (CCNC)R.W. “Chip” Watkins, MD, MPH, FAAFPBrent Hazelett, MPANorth Carolina Academy of Family Physicians (NCAFP)Elizabeth Walker Kasper, MSPHNorth Carolina Healthcare Quality Alliance (NCHQA)
55Feel free to contact me: Questions?Feel free to contact me:David Halpern, MD, MPH(215)