Top 5 Hidden PCMH Benefits

Climbing the ladder of PCMH success for primary care practices.“Courage is the ladder on which  on the other virtues mount.” — Clare Boothe Luce

Lots of practices are either currently involved in or thinking about earning recognition as a Patient-Centered Medical Home (PCMH). It’s not necessarily an easy process to go through, but yet according to the National Committee on Quality Assurance, they’re receiving many new applications each month.

If you’re not quite familiar with what PCMH recognition means, here’s a quick update. NCQA devised an application in 2006 whereby primary care practices could receive national recognition for things like same-day appointment scheduling, coordinating and tracking patient referrals, and meaningful use of their electronic health record system. NCQA updated their application in 2008 and again just this year.

It definitely takes some courage to embark on this process. The application can be time-consuming and lengthy, with some practices taking over a year to produce reports, fill out the application, provide supporting documentation and finally submitting the application.

What’s even more courageous about this is that many practices climb the ladder of PCMH recognition without even the promise of immediate increases in reimbursement. So why do it? Well, first of all, there’s hope that practices will someday receive additional reimbursement for their medical home efforts. That’s because, according to a study released from the Patient-Centered Primary Care Collaborative, the very attributes that are high on the medical home scale, also saves the system lots of money while improving quality of care. Here’s some examples listed in their brochure. Medical Home patients experienced:

  • A 14% reduction in hospitalization rates
  • A 29% reduction in emergency room visits
  • A reduction in overall costs for PCMH practices
  • An increase in patients reaching target levels on HEDIS quality measures
  • Improved staff satisfaction in PCMH practices

I’ve found that practices may see other benefits of going through the NCQA PCMH recognition process. I worked with a practice that just recently submitted their NCQA application and we discovered many “hidden” benefits of going through the PCMH recognition process. These are:

  1. Setting Goals. We hear one common comment when working with a practice on their PCMH application. Whether we’re talking about scheduling or test tracking, the response is the same.  “We’re already doing this.” But when we sit down and work with the practice to prepare the documentation for the application, we learn something a little different. It’s true the practice may already have same-day appointment scheduling, but they’ve not developed any metrics to determine if they’re doing it well. NCQA requires a practice policy statement. And not just any statement. One with target goals. Is the practice meeting this goal 70% of the time? It’s a question that needs to be answered. And this development of a goal and measuring against it is something new for most practices.
  2. Job Descriptions. Some practices just don’t see the need for having job descriptions. This is especially true for smaller practices. Job descriptions are one of those things that don’t seem necessary when everything’s going great, but the second you realize your new hire might have been a mistake, a job description can be an important resource. And they make great documentation for some of the elements in NCQA. Need to demonstrate how the nurse educates patients? A job description can be one way of doing that. Going through the NCQA PCMH process is a great opportunity to either add job descriptions or to review and fine-tune existing ones.
  3. Performance Measures.  “Can you believe that Angie took over 300 calls last week?” That’s the kind of statement a practice manager shared with her front office staff recently. It definitely helped other staff to better understand the difficulty of Angie’s job. In addition, it gave that practice manager some needed metrics to help evaluate Angie’s job. For practice managers, going through the PCMH recognition process can help quantify work performance which can be a great tool in evaluating and coaching staff.
  4. Reports. A well-developed NCQA application includes a lot of reports. Reports from your practice management system. Reports from your EHR. Reports from your ePrescribing system. Like I say, lots of reports. Most of the time when I first begin working with a practice on their application, I see a lot of head-scratching. Mostly from practice managers who are wondering how they can produce documentation that shows what they are actually doing. It’s one thing to say that you are returning phone calls within an allotted period of time, it’s quite another to produce a report that demonstrates this. “Working on the NCQA application forced me to learn our practice’s EHR system in a way I had never used it before,” said a recent practice manager. She knew the information was there, the question was how to get to it. But she emerged from the process pleased to have a new and more thorough understanding of the EHR reporting capability.
  5. Bring it Home. This is one area that I think speaks to the nature of the “home” in Patient-Centered Medical Home.  Think about it, what words come to mind when you think of home? Does feeling cared for come to mind? PPC Elements 2 and 9 both request that practices not only develop lists of patients meeting identified criteria, but reaching out to those patients with reminders to schedule an appointment. That’s a part of what can help a patient feel cared for in a practice. It may not be something that a lot of primary care practices are accustomed to, but it is definitely something that brings the “home” to the medical home.

If you’re contemplating taking your practice through the NCQA recognition process for Medical Home, it will definitely take some courage. You know it can be a difficult and time-consuming ladder to climb, but you can look forward to the many direct and celebrated benefits. And you can be pleasantly surprised by some of the “hidden” benefits for your practice as well.

 

 

3 Responses to “Top 5 Hidden PCMH Benefits”

  1. Good article validating many of the experiences we are living with five FQHCs transforming to the medical home model. The realization of staff and senior management that “change will occur” in this process if we are to be successful is a big challenge. I am concerned that support is declining as the realities of data, targets, ongoing cycles of improvement and change fatigue take a toll.

    How do I rekindle that early excitement?

  2. […] which shares results of various PCMH pilots from around the country. Share with them about the Hidden Benefits of PCMH recognition. Find out what their questions are and see if you can find answers. There may be others […]

  3. Marly McMillen Beelman says:

    Carol, thanks for your comment. I decided to write the answer as blogpost, PCMH Recognition: Maintaining Momentum

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