Re­mod­eled med­i­cal-home rules

Stan­dard-set­ters try­ing to de­fine what pa­tients want

Modern Healthcare - - Front Page - Andis Robeznieks

Or­ga­ni­za­tions vy­ing to as­sess whether prac­tices are pa­tient-cen­tered med­i­cal homes are still try­ing to de­fine and mea­sure what pa­tients want. The Na­tional Com­mit­tee for Qual­ity As­sur­ance last week un­veiled PCMH 2011, the up­dated ver­sion of the med­i­cal home stan­dards it first re­leased in 2008. At the same time, the NCQA was work­ing with the U.S. Agency for Health­care Re­search and Qual­ity on a med­i­cal home ver­sion of the Con­sumer As­sess­ment of Health­care Providers and Sys­tems pa­tient sur­vey.

The Joint Com­mis­sion, on the same day the NCQA is­sued its new guide­lines, be­gan a field re­view of its “Pri­mary Care Home” am­bu­la­to­rycare ac­cred­i­ta­tion pro­gram, which will be open for com­ment un­til March 14, with a July launch date tar­geted. And the Ac­cred­i­ta­tion As­so­ci­a­tion for Am­bu­la­tory Health Care, which of­fers an ad­junct med­i­cal home ac­cred­i­ta­tion path, is now de­vel­op­ing a cer­ti­fi­ca­tion pro­gram that strictly fo­cuses on the unique qual­i­ties of a pa­tient-cen­tered med­i­cal home.

Rec­og­niz­ing pa­tient-cen­tered med­i­cal home prac­tices has been a suc­cess­ful busi­ness line for the NCQA. But there was one prob­lem: Pa­tients be­ing treated at a pa­tient-cen­tered med­i­cal home didn’t al­ways feel it was all about them and, as re­sult, pa­tient sat­is­fac­tion scores were not mov­ing up enough to re­flect the ef­fort prac­tices ex­pended to achieve NCQA med­i­cal home recog­ni­tion.

Pa­tri­cia Bar­rett, NCQA vice pres­i­dent for prod­uct devel­op­ment, ac­knowl­edged that prac­tices could do ev­ery­thing re­quired by the NCQA and other or­ga­ni­za­tions to qual­ify as a med­i­cal home “and still alien­ate pa­tients.”

With the help of a Com­mon­wealth Fund grant, work on re­vised stan­dards be­gan “al­most out of the gate” af­ter the re­lease of the first stan­dards in 2008, Bar­rett said. The NCQA be­gan cat­a­loging mar­ket in­tel­li­gence in 2009 from pri­mary-care med­i­cal so­ci­eties, con­sumer groups and sim­i­lar or­ga­ni­za­tions.

The re­sult was a new set of stan­dards that in­cluded “a stronger voice of the pa­tient” such as method­olo­gies to in­clude pa­tient feed­back in qual­ity-im­prove­ment ef­forts, pro­vid­ing ser­vice in the pa­tients’ pre­ferred lan­guages, help­ing pa­tients with self-care and iden­ti­fy­ing pa­tients who may be con­sid­ered high risk for fail­ing health. An­other fo­cus was to link med­i­cal home ob­jec­tives with the HHS mean­ing- ful-use cri­te­ria for health IT fund­ing.

“We want to strike the right bal­ance be­tween high tech and high touch,” Bar­rett said. A draft of the stan­dards was re­leased last June (June 14, 2010, p. 10) and re­ceived a mostly pos­i­tive re­sponse, Bar­rett said. “I didn’t hear any neg­a­tive feed­back other than ‘This is go­ing to be hard.’ ”

An in­ter­ac­tive tool will be added to the NCQA web­site some­time next month that will help guide prac­tices through the new stan­dards, while prac­tices can still achieve recog­ni­tion un­der the 2008 stan­dards through the end of this year, Bar­rett said.

Ge­of­frey Charl­ton-Perrin, a spokesman for the Ac­cred­i­ta­tion As­so­ci­a­tion for Am­bu­la­tory Health Care, de­clined to com­ment on the new NCQA stan­dards ex­cept to say that he felt his or­ga­ni­za­tion’s process “is vastly su­pe­rior to any­one’s, in­clud­ing NCQA” be­cause it in­volves on­site vis­its by ac­cred­i­ta­tion sur­vey­ors.

While the AAAHC has ac­cred­ited more than 60 fa­cil­i­ties as med­i­cal homes since 2008 (in­clud­ing some am­bu­la­tory fa­cil­i­ties for the U.S. Coast Guard and Air Force), the NCQA has rec­og­nized more than 1,500 prac­tices as med­i­cal homes in roughly the same time pe­riod.

Dr. So­mava Stout, vice pres­i­dent for pa­tient-cen­tered med­i­cal home devel­op­ment for Cam­bridge (Mass.) Health Al­liance, said she was on the med­i­cal home jour­ney be­fore the term “med­i­cal home” had been in­vented. Stout, re­cently pro­moted to the newly cre­ated po­si­tion at the Har­vard Uni­ver­sity-af­fil­i­ated pub­lic health­care sys­tem, said the ini­tial stan­dards fo­cused on “back­ground stuff” such as IT func­tions and pa­tient safety, which the pub­lic doesn’t nec­es­sar­ily see. “Do pa­tients re­al­ize their care is safer now that their doc­tor uses a com­puter?” she asked.

And while they may have had short­com­ings, Stout said the ini­tial stan­dards were use­ful in pro­vid­ing a struc­ture to the med­i­cal home con­cepts of in­creased ac­cess, care co­or­di­na­tion and team-based care—and in pro­vid­ing re­as­sur­ance that prac­tices were mov­ing in the right di­rec­tion.

“You just can’t flip a switch,” Stout said. “One of the things we do over and over again in health­care is we don’t re­mem­ber to in­clude the pa­tient as a part­ner in de­sign­ing their (per­sonal) health­care sys­tem. Even if we’re do­ing some­thing we think is good for the pa­tient, they need to un­der­stand it.”

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