Patient Centered Medical Home 2011 Standards

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1 PCMH Standard 6 1

2 Patient Centered Medical Home 2011 Standards 2

3 Today s Agenda PCMH 6 PCMH 6 PCMH 6 Elements A-B Elements C-E Elements F-G

4 Standard 6 A MEASURE PERFORMANCE

5 PCMH 6A Measure Performance

6 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 Factor 1 Sample Documentation

7 PCMH 6A Measure Performance

8 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

9 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

10 PCMH 6A Measure Performance

11 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

12 PCMH 6A Measure Performance

13 PCMH 6A Factor 4 Documentation Options Uniformed Data Set/ HRSA 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. 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

14 PCMH 6A Factor 4 Sample Documentation

15 Standard 6 B Patient Experience

16 New Focus on the Patient

17 PCMH 6B Measure Patient/Family Experience

18 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?

19 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?

20 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?

21 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?

22 PCMH 6B Factor 2

23 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

24 PCMH 6B Factor 3

25 PCMH 6B Factor 4

26 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.

27 PCMH 6C Implement Continuous QI

28 PCMH 6C Implement Continuous QI What are the performance measures from A&B?

29 PCMH 6C Implement Continuous QI NCQA Supplemental Worksheet: Documentation for Factors 1-3

30 PCMH 6C Implement Continuous QI Example documentation for factor 1. Meeting Notes For QI reporting

31 PCMH 6D Demonstrate Continuous QI

32 PCMH 6D Demonstrate Continuous QI

33 PCMH 6D Demonstrate Continuous QI

34 PCMH 6E Report Performance

35 PCMH 6E Report Performance

36 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

37 PCMH 6F Report Data Externally

38 PCMH 6E Report Data Externally Factor 1/CMS Core Measures for all EP's Medicaid and Medicare Measure Recommended Measure Title Recommended Measure Description 0013 AMA Hypertension: Blood Pressure Measurement 0028a 0028b AMA AMA Preventive Care and Screening Measure Pair: a.tobacco Use Assessment Preventive Care and Screening Measure Pair: b.tobacco Cessation Intervention 0421 QIP Adult Weight Screening and Follow-Up 0024 NCQA Alternate Core for all EP's Medicaid and Medicare Weight Assessment and Counseling for Children and Adolescents 0038 NCQA Childhood immunization Status 0041 AMA Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old 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. 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. Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who received cessation intervention. 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. 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. 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. Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

39 PCMH 6E Report Data Externally

40 PCMH 6E Report Data Externally taken from the CMS Attestation User Guide

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