Medical home recognition revised to address physician feedback
Many doctors in accredited medical homes complain about the difficulty in obtaining recognition from the National Committee on Quality Assurance (NCQA), the largest accreditation body for medical homes.
They raise several issues, including the challenge of understanding what NCQA wants, the relevance of some requirements and the voluminous documentation required. Other organizations, including the Joint Commission, URAC and the Accreditation Association for Ambulatory Health Care, also accredit medical homes, but NCQA recognizes the vast majority of them.
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NCQA says it has heard these complaints and taken steps to address them. Aided by a physician advisory committee, NCQA redesigned both its process and its criteria in the 2017 medical home recognition program it announced in early April. While doctors are just starting to read the fine print, some of them say they are encouraged by what they’ve seen so far.
Here’s what primary care physicians need to know about the new NCQA approach and how it differs from the previous one.
Challenges of the former process
The NCQA has been recognizing medical homes since 2008. Under its 2014 criteria, which were in effect until April 3, a practice could aspire to one of three levels of recognition, depending on how many points it received. There were six “standards,” including access, team-based care, population health management, care planning, care coordination and performance measurement. Practices had a choice of 27 elements across these six domains, but they had to meet the criteria for a particular element in each domain. Under “enhance access,” for example, “patient-centered appointment access” was a must-pass element.
In applying for NCQA recognition, a practice had to provide written documentation showing that its staff and providers were conducting the requisite activities. All of that documentation had to be gathered and presented to NCQA at one time. If the application was incomplete or the evidence was unsatisfactory, the site was not recognized as a medical home. If the practice was recognized, it had to repeat this process every three years to renew its accreditation.
Internist Yul Ejnes, MD, of Cranston, Rhode Island, the chairman of NCQA’s physician advisory committee, says that some of the NCQA’s earlier documentation requirements didn’t show anything about the quality of care in his practice. For example, he says, his staff had to record what percentage of his patients used the practice’s patient portal and what percentage of scripts he was sending electronically.
“If your patients are happy that they can reach you, by whatever means is convenient for them, what does it matter what percentage of patients are using the portal?” he says. “Those are the kinds of things that seemed like busy work that had no impact on how well we did as a medical home.”
While Ejnes is in a large group that can handle the application paperwork, he notes it is much more difficult for a small practice. His own primary care doctor, he says, had to hire a part-time person to help his staff complete the NCQA application.
So did Carolina Internal Medicine, a nine-doctor practice in Asheville, North Carolina, says Kenneth Kubitschek, MD, a partner in the group.
Susan Kressly, MD, who has a primary care practice in Warrington, Pennsylvania, says her group didn’t hire anybody from outside. But she had to work nights and weekends to fill out and provide documentation for the NCQA application. Altogether, this work took her and her staff about 100 hours each time they applied for or renewed their recognition, she estimates.
NCQA’s 2017 recognition program includes updated standards and a substantially revised process for recognition, says Michael Barr, MD, executive vice president of the organization’s quality measurement and research group.