Where to Get Started with NCQA and the PCMH Recognition Process?

Where to Get Started with NCQA and the PCMH Recognition Process?

May 23, 2018

Jean Lockington, MA, RN, PLNC, PCMH CCE, a specialist in NCQA Accreditation, Recognition and Certification Programs, creates a checklist to help practices understand what is involved in getting started with PCMH Recognition. Jean offers her consulting assistance, through Professional Services Network, Inc., which includes assessment of documentation compliance to NCQA standards, expert blueprint for compliance, gap analysis, assembling of your application, data analysis support, policy and procedure development, ISS preparation, assistance, on-site mock surveys, file audits, and program design

For assistance with your accreditation goals, please contact Professional Services Network, Inc. (PSN) at 1-877-753-1776

 

Where to Get Started with NCQA and the PCMH Recognition Process?

Where do I begin? The process for preparation can be very overwhelming so here are a few key tidbits!!

  • Be sure to obtain the most current standards which at this time is the 2017 NCQA PCMH Standards; begin to review the standards, see what processes the practice may already be performing or can be easily modified to meet the standards.
  • Talk with team members in the practice; do they feel they are working as a team or each staff member is doing “their own thing.” Talk about Team Based Care. What do you think is the role for each member of the practice?
  • How can the staff and practice move into a model of transformation?
  • Even before the practice moves to transformation, there must be a commitment from everyone within the practice for willingness to move forward with PCMH even though “changes” will be involved.
  • All members in the practice are required to have a firm commitment working with changing processes to assist in having a patient centered home.
  • What type of EMR is used by the practice? Is the practice using it to the fullest? Practices can research with their medical record representatives if their EMR has been recognized by NCQA and obtain any automatic credit for certain standards. This is a great start for the practice to know prior to starting their preparation since points are allocated by NCQA for compliance to certain standards if practices are using the version of the EMR recognized by NCQA.
  • Each practice thinking to begin the preparation process for PCMH must develop a PCMH Champion or Project Manage who is an individual who will assist the practice to meet the standards that are both required and elective with PCMH Recognition.
  • Document the roles and responsibilities for each team member; how does he/she support the PCMH model and role in transformation.
  • Ensure each team member is functioning and working at the highest level of their license, An RN should not be completing receptionist duties such as “check-in” but assisting high risk patients in the coordination of their care or follow-up of patients who have been discharged from the hospital.
  • Research the costs involved with working on PCMH by developing a budget with costs for submission of application to NCQA, any staff overtime for work with PCMH Project or costs related to any work with a consultant. Practices can’t take time away from patient care.
  • Develop a timeline for preparation and submission of documents to NCQA. Many times, once the practice starts the preparation they find it takes longer than initially thought. Timeline and development of a work or project plan assists the practice to stay on target.
  • Be sure to gain buy-in from all team members since one person not willing to engage in the project can really  “ bulldoze”  the preparation and enthusiasm for  the remainder of the team.

 

Please contact Professional Services Network, Inc. (PSN) if you would like my further assistance.

 

About Professional Services Network, Inc.

Professional Services Network, Inc. (PSN) works with clients nationwide in the search and recruitment of experienced nurses in utilization review, quality and case management for temporary assignment and direct hire opportunities. Additionally, PSN’s consultants work with provider and managed care organizations seeking accreditation or re-accreditation with URAC or NCQA. For additional information regarding our services contact us toll-free at 877-753-1776 or email us at [email protected]