1. All materials © 2013, National Committee for Quality Assurance Standards Workshop Part 2 Patient-Centered Specialty Practice (PCSP) Recognition Program

2. 2 Agenda Part 1 Content of PCSP Standards and Guidelines – Standards 1 – 3 – Documentation Examples* Agenda Part 2 Content of PCSP Standards and Guidelines – Standards 4 – 6 – Documentation Examples* *Examples in the presentation only illustrate the element intent. They are NOT definitive nor the only methods of documenting how the requirements may be met.

3. 3 PCSP 4: Plan and Manage Care Intent Collaborate with patient/family/caregiver and PCP to develop and implement care plan Review and reconcile medications E-prescribe Meaningful Use Use EHR to identify patient education resources Review and reconcile medications Use an e-prescribing system to write and transmit prescriptions Compare meds. With formularies, check for generics, drug-drug and drug-allergy interactions

4. 4 PCSP 4: Plan and Manage Care Elements PCSP 4A: Care Planning and Self-Care Support PCSP 4B: Medication Management - MUST PASS PCSP 4C: Use of Electronic Prescribing

5. 5 PCSP 4A: Care Planning and Self-Support The practice provides the following care management and self-care support for practice-specific conditions: 1.Conduct pre-visit preparations 2.Assess patient risk status to identify patients needing additional support and services 3.Collaborate with the patient/family/caregiver to develop a specialist’s plan of care that includes patient’s goals, potential barriers/self-care ability - CRITICAL FACTOR 4.Share specialist’s plan of care including recommendations for self-care support with the PCP and referring clinician - CRITICAL FACTOR

6. 6 PCSP 4A: Care Planning and Self-Support The practice provides the following care management and self-care support for practice-specific conditions: 5.Give the patient/family/caregiver a written specialist’s plan of care including self-care recommendations. 6.Provide educational resources or refer patients/families/caregivers to assist in self- management 7.Assess/address barriers when patient has not met treatment goals 8.Use an EHR to identify patient-specific education resources and provide to more than 10 percent of patients+ + Stage 2 Core Meaningful Use Requirement

7. 7 PCSP 4A: Care Planning and Self-Support 11 Points Scoring –100% - 6-8 factors, including Factors 3 and 4 –75% - 4-5 factors, including Factors 3 and 4 –50% - 2-3 factors, including Factors 3 and 4 –25% - No scoring option –0% - 0-1 factor, or does not meet Factors 3 and 4 Documentation –Factors 1-7: Written process and examples –Factor 8: Report with numerator, denominator and percentage

8. 8 PCSP 4A: Example Pre-visit Form Patients complete form pre-visit: Focus of today’s visit Medications Allergies Pain assessment Flu vaccine Depression assessment Recent ER visit

9. 9 PCSP 4A: Example Patient Education Prenatal Care: Steps Toward a Healthy Pregnancy Prenatal Session #1 PROGRAM: Comprehensive Perinatal Services Program TIME: 1-1 ½ Hours OBJECTIVES By the end of the session, the participant will be able to: 1. Identify basic anatomy of human reproductive system 2. Identify common discomforts of pregnancy including aspects of fetal growth and development 3. Identify danger signs during pregnancy and action to take during complications 4. Identify lab tests including the importance of ultrasound 5. Understand the importance of Oral health during pregnancy Practice must also attach a complete set of education materials that could be provided to the patient.

10. 10 PCSP 4B: Medication Management The practice has a process and demonstrates that it systematically manages medications prescribed by the practice in the following ways: 1.Reviews and reconciles medications for more than 50 percent of patients received from another care setting or a relevant visit+ 2.Provides information about new prescriptions from specialty practice to patients/families/caregivers. 3.Coordinates medication management and reconciliation with the PCP, referring clinician and patient/family/caregiver

11. 11 PCSP 4B: Medication Management The practice has a process and demonstrates that it systematically manages medications prescribed by the practice in the following ways: 4.Assesses patient/family/caregiver understanding of medications from specialty practice 5.Assesses patient response to medications from specialty practice and barriers to adherence 6.Documents over-the-counter medications, herbal therapies and supplements + Stage 2 Core Meaningful Use Requirement

12. 12 PCSP 4B: Medication Management Must Pass 5 Points Scoring –100% - 5-6 factors –75% - 4 factors –50% - 3 factors –25% - 2 factors –0% - 0-1 factors Documentation: –Factor 1: Report with numerator, denominator and percentage –Factors 2-6: Documented process and three examples for each factor

13. 13 PCSP 4B: Example Medication Reconciliation Reconcile meds. at each visit for patient safety and effectiveness of medications 1.Pts. bring list or meds. to each visit; reminded when appt. scheduled; signs in pt. rooms 2.Med. asst. reviews meds. at each visit 3.MD reviews current meds.; discusses pt. concerns 4.Motivational interviewing/shared decision- making to help with risks/benefits of meds. 5.MD/staff teach pt. about med. administration 6.Follow-up call to pt. when major change to meds. 7.Check with pt. if refill requests are conflicting

14. 14 PCSP 4B: Patient Role in Med. Management Posted in office to encourage patients to help managing their medications

15. 15 PCSP 4C: Use of Electronic Prescribing The practice uses an electronic prescription system with the following: 1.Writes at least 75 percent of eligible prescriptions electronically. 2.More than 50 percent of eligible prescriptions written by the practice are compared to drug formularies and electronically sent to pharmacies+ 3.Enters electronic medication orders into the medical record for more than 60 percent of patients with at least one medication in their medication list+ 4.Performs patient-specific checks for drug-drug and drug-allergy interactions+ 5.Alerts prescriber to generic alternatives + Stage 2 Core Meaningful Use Requirement

16. 16 PCSP 4C: Use of Electronic Prescribing 2 Points Scoring –100% - 3-5 factors –75% - 2 factors –50% - 1 factor –25% - No scoring option –0% - 0 factors Documentation –Factors 1-3: Report with a numerator, denominator and percentage –Factors 4 and 5: Report or screen shot demonstrating capability VS

17. 17 PCSP 4C: Example Electronic Prescription Writing Prescription Writing Activity Electronic 57% 2563 Rx Printed, given to patient 31% 1419 Rx Print, fax to pharmacy 1% 89 Rx _______________________________________ TOTAL Rx 4474 Rx % E-RX 89%

18. 18 PCSP 4C: Example Drug-Drug Interactions Drug-Drug Interactions

19. 19 PCSP 4C: Example Prescription Allergy

20. 20 PCSP 4C: Example Generic Alternatives

21. 21 PCSP 5: Track and Coordinate Care Intent Track/follow-up on lab and imaging results Exchange test results with primary care Track/follow-up on referrals Coordinate with hospitals/ ERs; transition patients back to primary care Meaningful Use Incorporate clinical lab test results into the medical record Electronically exchange clinical information with other clinicians and facilities Provide electronic summary of care record for referrals and care transitions CMS EHR Incentive Programs: http://www.cms.gov/Regulations- and-Guidance/Legislation/EHRIncentivePrograms/index.html

22. 22 PCSP 5: Track and Coordinate Care Elements PCSP 5A: Test Tracking and Follow-Up PCSP 5B: Referral Tracking and Follow-Up PCSP 5C: Coordinate Care Transitions

23. 23 PCSP 5A: Test Tracking and Follow-Up The practice has a documented process for and demonstrates that it: 1.Requests and tracks receipt of test results from PCP and referring clinician 2.Provides PCP and referring clinician with results of relevant tests ordered by the specialist - CRITICAL FACTOR 3.Tracks lab tests until results are available, flagging and following up on overdue results 4.Tracks imaging tests until results are available, flagging and following up on overdue results 5.Flags abnormal lab results, bringing them to the attention of the clinician

24. 24 PCSP 5A: Test Tracking and Follow-Up (cont.) The practice has a documented process for and demonstrates that it: 6.Flags abnormal imaging results, bringing them to the attention of the clinician 7.Patients/families/caregivers are notified about normal and abnormal lab and imaging test results 8.More than 30 percent of laboratory orders are electronically recorded in the patient record+

25. 25 PCSP 5A: Test Tracking and Follow-Up (cont.) The practice has a documented process for and demonstrates that it: 9.More than 30 percent of radiology orders are electronically recorded in the patient record+ 10. Electronically incorporates more than 55 percent of all clinical lab test results into structured fields in medical record+ 11. More than 10 percent of scans and tests that result in an image are accessible electronically++ + Stage 2 Core Meaningful Use Requirement ++ Stage 2 Menu Meaningful Use Requirement

26. 26 PCSP 5A: Test Tracking and Follow-Up 5 Points Scoring –100% - 6-11 factors, including factor 2 –75% - 4-5 factors, including factor 2 –50% - 3 factors, including factor 2 –25% - 1-2 factors, including factor 2 –0% - 0 factors or does not meet factor 2 Documentation –Factors 1-7: Documented process and report with 5 days of data or three examples of meeting the process for each factor (demonstrate the implemented process) –Factors 8, 9, 10, 11: Report with a numerator, denominator and percentages

27. 27 PCSP 5A: Example, Lab Process Missing Flagging Overdue labs and FU

28. 28 PCSP 5A: Policy for Abnormal Test Results Policy: Definitions for Abnormal Test Result Categories and Reporting Requirements for Each Abnormal Abnormal (Priority) Abnormal (Critical)

29. 29 PCSP 5A: Example Referral Tracking

30. 30 PCSP 5A: Example Test Tracking Log DATA COLLECTED Patient name DOB Provider Order date Test ordered Urgency Date results received Results normal/abnormal Date results to provider Date results to patient

31. 31 PCSP 5A: Example Electronic Test Tracking All lab and imaging tests are tracked until results are available Overdue results are flagged Abnormal results are flagged Practice tracks: Date ordered Overdue Abnormal Priority Patient name Provider Order description Last appointment Next appointment

32. 32 PCSP 5A: Example Letter for Patient Notification of Abnormal Imaging Results Patient/family was notified by provider of abnormal test results and given follow-up instructions

33. 33 PCSP 5B: Referral Tracking and Follow-Up The practice coordinates referrals to other (secondary) specialists by: 1.Consulting with PCP and referring clinician and patient/family/ caregiver regarding secondary referrals 2.Giving the consultant or specialist the clinical reason for the referral and pertinent clinical information - CRITICAL FACTOR 3.Tracking the status of the referral, including required timing for receiving a specialist’s report 4.Following up to obtain specialist’s report

34. 34 PCSP 5B: Referral Tracking and Follow-Up (cont.) The practice coordinates referrals to other (secondary) specialists by: 5.Establishing and documenting agreements with specialists in the medical record if co-management is needed 6.Asking patients/families/caregivers about self-referrals and requesting reports from clinicians 7.Assuring the PCP and original referring clinician are notified of the secondary referral results. 8.Providing an electronic summary of care record to another provider for more than 50 percent of referrals+

35. 35 PCSP 5B: Referral Tracking and Follow-Up (cont.) The practice coordinates referrals to other (secondary) specialists by: 9.Electronically transmitting a summary of care record to another care provider for more than 10 percent of care referrals+ 10.Conducting one or more successful electronic exchanges with a recipient who has technology developed by a different EHR developer or successfully tests with the CMS designated test EHR.+ + Stage 2 Core Meaningful Use Requirement

36. 36 PCSP 5B: Referral Tracking and Follow-Up 6 Points Scoring –100% - 8-10 factors, including Factor 2 –75% - 6-7 factors, including Factor 2 –50% - 4-5 factors, including Factor 2 –25% - 1-3 factors, including Factor 2 –0% - 0 factors Documentation –Factors 1-4, 6&7: 1.Documented process and 2.Reports or logs showing data collection in a tracking system –Factor 5: At least three examples –Factors 8 and 9: Report with numerator, denominator and percentages –Factor 10: Screen shot showing capability

37. 37 PCSP 5B: Example Referral Tracking Referral Tracking Data - 5 days Date ordered Referring provider Diagnosis Referred to Supporting clinical information Urgency Type of referral Appointment date Date results received Date of follow-up for missing report

38. 38 PCSP 5B: Example Co-Management Policy

39. 39 PCSP 5B: Example Follow-Up to Get Referral Report

40. 40 PCSP 5C: Coordinate Care Transitions For conditions managed by the specialist, the practice systematically: 1.Demonstrates its process for identifying patients with a hospital admission and patients with an emergency department visit 2.Demonstrates its process for sharing clinical information with admitting hospitals or emergency departments 3.Demonstrates its process for consistently obtaining patient discharge summaries from the hospital and other facilitiescont.

41. 41 PCSP 5C: Coordinate Care Transitions (cont.) For conditions managed by the specialist, the practice systematically: 4.Demonstrates its process for transitioning patients back to the primary care practice 5.Provides an electronic summary-of-care record to another care facility for more than 50 percent of transitions of care+ 6.Electronically transmits a summary of care record to another care setting for more than 10 percent of care transitions+ + Stage 2 Core Meaningful Use Requirement

42. 42 PCSP 5C: Coordinate Care Transitions 5 Points Scoring –100% - 4-6 factors –75% - 3 factors –50% - 2 factors –25% - 1 factor –0% - 0 factors Documentation –Factors 1-4: 1. Documented process and 2. Three examples –Factors 5 and 6: Report with a numerator, denominator and percentages

43. 43 PCSP 5C: Example Identifying Patients in Facilities Practice receives admission reports electronically from hospital

44. 44 PCSP 5C: Example ER Visit Follow-Up Log

45. 45 PCSP 5C: Pediatric to Adult Transition Diabetes Care Self-Assessment Self-assessment of worries, concerns, burdens related to diabetes and preparation for transitioning I would like to talk about: Challenged by diabetes burdens Social/emotional/cognitive issues Transition preparation/readiness to move on

46. 46 PCSP 5C: Clinical Summary for New Health Care Team

47. 47 PCSP 6: Measure and Improve Performance Intent Measure clinical performance, coordination of care, utilization affecting costs, access to care, patient experience and report performance Use and monitor effectiveness of quality improvement process Meaningful Use Report: Ambulatory quality measures to CMS Immunization data to registries Syndromic surveillance data to public health agencies Cancer cases to registry

48. 48 PCSP 6: Measure and Improve Performance Elements PCSP 6A: Measure Performance PCSP 6B: Measure Patient/Family Experience PCSP 6C: Implement & Demonstrate Continuous Quality Improvement - MUST PASS PCSP 6D: Report Performance PCSP 6E: Use Certified EHR Technology

49. 49 PCSP 6A: Measure Performance The practice measures or receives data on: 1.At least three clinical measures related to the practice specialty 2.Coordination of care results 3.At least two utilization measures affecting health care costs 4.Performance data stratified for vulnerable populations (to assess disparities in care). 5.Timely access to appointments based on established criteria

50. 50 PCSP 6A: Measure Performance 5 Points Scoring –100% - 4-5 factors –75% - 3 factors –50% - 1-2 factors –25% - No scoring option –0% - 0 factors Documentation –Factors 1-5: Reports showing performance

51. 51 Vulnerable Populations Defined “Those who are made vulnerable by: –their financial circumstances or place of residence, –health, age, personal characteristics, –functional or developmental status, ability to communicate effectively, and –presence of chronic illness or disability.” Source: AHRQ

52. 52 Vulnerable vs. High Risk

53. 53 PCSP 6A: Example Chronic Care Clinical Measures

54. 54 NCQA Clinical Program Recognition Where Can it Be Used to Meet Elements? NCQA Clinical Recognition Programs –Diabetes Recognition Program (DRP) –Heart/Stroke Recognition Program (HSRP) Credit for Clinical Program Recognition may be used for meeting some requirements if 75% of clinicians are Recognized: –PCSP 6A Factor 1 –PCSP 6C Factors 1 and 7 (if renewed), for Element A portion –PCSP 6 D Factor 1, 2 and 3 for Element A portion

55. 55 NCQA Clinical Program Recognition Where Can it Be Documented to Meet Elements?

56. 56 PCMH 6 ELEMENT A: Factor 3 Care Managers receive referrals from PCP'S, Hospitalists, Social Workers or family members requesting evaluation for patients to be treated at an alternative level of care (home, SNF) or in the office. The team has had a 22% success rate in saving hospital admissions since Nov 2007. CARE MANAGEMENT ACTIVITIES 2014 August - December TOTAL CM REFERRALS / SAVED ADMISSIONS 2014 TOTAL TO DATE AUGSEPTOCTNOVDEC2014 TOTAL CM REFERRALS2202022992212191161TOTAL CM REFERRALS SAVED ADMISSIONS5753554957271SAVED ADMISSIONS FAILED ATTEMPTS5723320FAILED ATTEMPTS PCSP 6A: Example Measures Affecting Health Care Costs PCSP

57. 57 PCSP 6A: Example Data for Vulnerable Populations

58. 58 PCSP 6B: Measure Patient/Family Experience The practice obtains feedback from patients/families on their experiences with the practice and their care. 1.The practice conducts a survey (using any instrument) to evaluate patient/family experiences on at least three of the following categories: –Access –Communication –Coordination –Self-management support 2.The practice uses CAHPS** Clinician & Group (CG) Survey Tool 3.The practice obtains feedback on experiences of vulnerable patient groups 4.The practice obtains feedback from patients/families through qualitative means **Consumer Assessment of Healthcare Providers and Systems (CAHPS) https://www.cahps.ahrq.gov/clinician_group/

59. 59 PCSP 6B: Measure Patient/Family Experience 5 Points Scoring –100% - 3-4 factors –75% - No scoring option –50% - 2 factors –25% - 1 factor –0% - 0 factors Documentation –Factors 1-4: Provides reports with summarized results of patient feedback. A blank Survey Tool does not meet the intent of this element.

60. 60 PCSP 6B: Example of Reported CAHPS Questions for Patient Experience

61. 61 PCSP 6B: Example Patient Experience Data Jan 2015 March 2015

62. 62 2014 PCSP 6B: Example Patient Experience Survey Results Survey questions include: Access Communication NEEDS A THIRD CATEGORY 2014

63. 63 PCSP 6C: Implement & Demonstrate Continuous Quality Improvement The practice demonstrates ongoing monitoring of the effectiveness of its improvement process by: 1.Setting goals/acting to improve on at least three clinical quality or utilization measures 2.Setting goals/acting to improve quality on at least one patient experience measure 3.Setting goals/acting to improve timeliness of patient access 4.Setting goals/acting to improve coordination with primary care

64. 64 PCSP 6C: Implement & Demonstrate Continuous Quality Improvement The practice demonstrates ongoing monitoring of the effectiveness of its improvement process by: 5.Tracking results over time 6.Assessing the effect of its actions 7.Achieving improved performance on one measure 8.Achieving improved performance on a second measure 9.Setting goals and addressing at least one identified disparity in care/service for vulnerable populations

65. 65 PCSP 6C: Implement & Demonstrate Continuous Quality Improvement MUST PASS 4 Points Scoring –100% - 6-9 factors –75% - 4-5 factors –50% - 3-4 factors –25% - 2 factors –0% - 0-1 factor Documentation –Factors 1- 9: Reports or completed PCSP Quality Measurement and Improvement Worksheet

66. 66 PCSP 6C: Quality Measurement and Improvement Instructions

67. 67 PCSP 6C: Quality Measurement and Improvement Worksheet Performance Measures (A) Disparities in Care (A) Patient/Family Experience (B) Measure (C) Opportunity Identified (C) Initial Performance/ Measurement Period (A/B) Performance Goal (C) Action Taken and Date (C) Re-measurement Performance (C) Demonstrate Improvement (C)

68. 68 PCSP 6C, Factor 5: Example Tracking Data Over Time Aug-14 Sep-14 Oct-14 Nov-14 Dec-14

69. 69 PCSP 6D: Report Performance The practice shares performance data from Element A and Element B: 1.Within the practice, results by individual clinician 2.Within the practice, results across the practice 3.Outside the practice to patients or publicly, results across the practice or by clinician

70. 70 PCSP 6D: Report Performance 2 Points Scoring –100% - 3 factors –75% - 2 factors –50% - 1 factor –25% - no scoring option –0% - 0 factors Documentation –Factors 1-2: Reports to practice or clinicians and practice staff; explains how results are provided –Factor 3: Example of report to patients or the public

71. 71 PCSP 6D: Example Reporting by Clinician 123456 Blinded 6 Clinicians

72. 72 PCSP 6D: Example Practice Level Diabetes Data Jan-2015

73. 73 PCSP 6D: Example of External Reporting

74. 74 PCSP 6E: Use Certified EHR Technology 1.The practice uses an EHR system (or modules) that has been certified and issued a Certified HIT Products List (CHPL) Number(s) under the ONC (Office of the National Coordinator for Health Information Technology) HIT certification program 2.The practice attests to conducting a security risk analysis of its electronic health record (EHR) system (or modules) and implementing security updates as necessary and correcting identified security deficiencies+ 3.The practice demonstrates capability to submit electronic syndromic surveillance data to public health agencies electronically++

75. 75 PCSP 6E: Use Certified EHR Technology (cont.) 4.The practice demonstrates capability to identify and report cancer cases to a public health central cancer registry electronically++ 5.The practice demonstrates capability to identify and report specific cases to a specialized registry electronically (other than a cancer registry)++ 6.The practice reports clinical quality measures to Medicare or Medicaid agency as required for Meaningful Use. 7.The practice demonstrates the capability to submit electronic data to immunization registries or immunization information systems.+ + 2 Core Meaningful Use Requirement ++Stage 2 Menu Meaningful Use Requirement

76. 76 PCSP 6E: Use Certified EHR Technology 0 Points Documentation –Factors 1-7: Responding “yes” or “no” in each element of the survey tool is an attestation that the practice meets the respective requirements

77. 77 Meaningful Use Attestation Accepted Attestation Attestation Tracking Information Attestation Confirmation Number

78. 78 NCQA Resources Available Free training each month http://www.ncqa.org/rptraining.aspx http://www.ncqa.org/rptraining.aspx Getting On Board Includes How to Submit as a Multi-site Standards (2-part program) Software Training Using the ISS System The Online Application

79. 79 NCQA Contact Information Visit NCQA Web Site at www.ncqa.org to:www.ncqa.org –Follow the Start-to-Finish Pathway –View Frequently Asked Questions –View Recognition Programs Training Schedule For questions about interpretation of standards or elements to submit a question to my.ncqa (Policy/Program Clarification Support & Recognition Programs)my.ncqa Contact NCQA Customer Support at 888-275-7585 M-F, 8:30 a.m.-5:00 p.m. ET to: –Acquire standards documents, application account, survey tools –Questions about your user ID, password, access

80. 80 Questions?