New medical home guidelines create cohesiveness across medical associations

Primary care practices wishing to become patient-centered medical homes face a growing number of organizations offering accreditation, each with its own set of standards and guidelines.

A PCMH is a team-oriented practice structure to formally track and improve disease management and clinical outcomes goals within your practice, allowing accredited PCMHs to apply for government and health plan financial incentives in which you share in the related healthcare cost savings.

In an effort to impose uniformity on the PCMH accreditation process, a coalition of four primary care associations has released a new set of recommendations that it hopes the accrediting organizations will adopt. The number of PCMHs, many of them in pilot programs, is on the rise and, as more stakeholders get involved, the definition of what constitutes a patient-centered medical home (PCMH) is crucial to funding and accreditation.

“This could create confusion and chaos if there is no clarity to it,” says Roland Goertz, MD, president of the American Academy of Family Physicians.

The AAFP, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association teamed up to write the recommendations. In 2007, the groups collaborated on their first set of guidelines, Joint Principles of the Patient-Centered Medical Home.

Of note, the new guidelines state that primary care physicians are best suited to lead medical homes due to their training and education, and that medical homes should not be led by midlevels such as NPs and PAs, says AAFP’s Goertz.

The new recommendations also call on PCMHs to do more than they have in the past, including:

• Incorporate the Joint Principles recommended in 2007.

• Address the complete scope of primary care services.

• Incorporate patient- and family-centered care emphasizing engagement of patients, their families, and caregivers.

• Engage all stakeholders in the development and implementation of the program.

• Align all elements of the program with meaningful use requirements.

• Identify essential standards, elements, and characteristics of the program.

• Address the core concept of continuous improvement.

• Allow for innovation.

• Acknowledge care coordination within the medical neighborhood.

• Identify PCMH recognition or accreditation requirements for training programs.

• Ensure transparency in program structure and scoring.

• Apply reasonable documentation/data collection requirements.

• Evaluate the program’s effectiveness and make improvements.

The coalition submitted the recommendations to the organizations accrediting PCMHs: the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC (formerly known as the Utilization Review Accreditation Commission). In addition, the Joint Commission plans to have its own accreditation program in place this year.

The accreditation organizations vary on the issue of whether midlevels can lead medical homes. AAACH specifies that medical homes be led by physicians while the NCQA allows nurse practitioners and physician assistants to be in charge in states that license them as independent practitioners. URAC simply defines homes as “clinician-led,” without specifying further.

The new guidelines reflect the maturation of the PCMH concept and the need to assess data to determine what works, says Shari Erickson, MPH, director of regulatory and insurer affairs for the ACP.

“We wanted to promote consistency,” she says. “There is a potential for confusion in (practices) feeling they have to meet different sets of guidelines.”

So where should a practice turn for guidance in being certified as a PCMH? In most cases they will follow the money, says NCQA’s Harkins. State Medicaid programs and other bodies offering incentives for PCMHs, as well as those running pilot programs, will decide what certification participating practices need.

For more information, go to:

National Committee for Quality Assurance
www.ncqa.org/tabid/1300/Default.aspx

Accreditation Association for Ambulatory Health Care
www.aaahc.org/eweb/StartPage.aspx

URAC
www.urac.org

Primary care PCMH guidelines
http://www.acponline.org/pressroom/pcmh_guidelines.htm?hp