Practice can achieve a passing score on all Must Pass Elements with Basic Health Information Technology Possible Status Number of Points Must Pass Elements at 50% Scoring Level Recognized – Level III 75- 100 10 out of 10 Recognized – Level II 50-75 10 out of 10 Recognized – Level I 25- 50 5 out of 10 Not Recognized 0 - 25 0 out of 10 Of the 30 elements in PPC-PCMH, 10 are Must Pass, that is, elements that a practice Must Pass at 50% or greater score to achieve Recognition. Practices that achieve less than 5 Must Pass elements receive a Not Recognized status. If there is a difference in Level achieved for the number of points and the Must Pass elements, the practice will be awarded the lesser level. For example, if a practice has 65 points but passes only 7 Must Pass Elements, the practice will achieve Level 1 Recognition. PPC 1 Must Pass Actions for Point Person responsible Ready for NCQA The person assigned to do the final review Standard Complete NCQA document linked Points Completed Points Pending Upload completed Total Points Element A x Yes No Yes No Yes No Element B x Yes No Yes No Yes No PPC 2 Element A Yes No Yes No Yes No Element B Yes No Yes No Yes No Element C Yes No Yes No Yes No Element D x Yes No Yes No Yes No Element E x Yes No Yes No Yes No
PPC 1 Must Pass Actions for Point Person Staff responsible Ready for NCQA The person assigned to do the final review Standard Complete NCQA document linked Points Completed Points Pending Upload completed Total Points A x Not started In process Done Not working on this Yes Yes B x Not started In process Done Not working on this Yes Yes Notes: Element 1A: Access and Communication Processes Must Pass 4 Points The practice establishes in writing standards for the following processes to support patient access: Do we have these factors in writing? Tools/ Resources needed Process Owner Due Date Scheduling each patient with a personal clinician for continuity of care Yes No Written policy for scheduling patients with a requested provider.
Coordinating visits with multiple clinicians and/or diagnostic during one trip Yes No Written procedures for staff for making appointments/ scheduling patient visit so that it is one trip to get the services they need. Determining through triage how soon a patient needs to be seen Yes No Written policy for triage on what needs to been seen urgently. Maintaining the capacity to schedule patients the same day they call Yes No Measuring capacity tool Scheduling same day appointments based on practice's triage of patients' conditions Yes No Procedures Scheduling same day appointments based on patient's/family's requests Yes No Open Access Article Providing telephone advice on clinical issues during office by physician, nurse or other clinician within a specified time Yes No Providing urgent response within a specific time, with clinician support available 24 hours a day, 7 days a week Yes No Policy on returning urgent calls What is your after hour’s coverage? Sending to ER doesn’t meet standard. Providing secure e-mail consultations with physician or other clinician on clinical issues, answering within a specified time Yes No Policy on checking e-mail If using, website for appt, rx refill, test results, etc… what is your policy? Tool: RMD if your EMR have this functionality
75% Practice identifies 2 items 50% Practice identifies 1 X 25% No scoring option 0% Practice identifies 0 items Examples/Notes: ( ) ( ) – are usually reports available for all counties in NC ( ) ( ) ( ) Element 2F: Use of System for Population Management 3 Points The practice uses electronic information to generate lists of patients and take action to remind patients or clinicians proactively of services needed, as follows: What is our current status? What needs to happen? Tools/ Resources needed Process Owner Due Date Patients needing pre-visit planning (obtaining tests prior to visit, etc.) Flowsheets, templates or screen Yes No EMR/RMD Flowsheet & CarePlan screen Patients needing clinician review or action Flowsheets, templates or screen shots Yes No EMR/RMD Flowsheet & CarePlan screen Patients on a particular medication Flowsheets, templates or screen shots Yes No Patients needing reminders for preventive care Flowsheets, templates or screen shots Yes No EMR/RMD Flowsheet & CarePlan screen Patients needing reminders for specific tests Flowsheets, templates or screen shots Yes No RMD Patient handout Patients needing reminders for follow-up visits such as for a chronic condition Flowsheets, templates or screen shots Yes No Screen shot of reminder email to patients/ copy of letters to patients Patients who might benefit from care management support. Flowsheets, templates or screen shots Yes No
Intent The practice collaborates with patients and families to pursue their goals for optimal achievable health. Element 4A: Practice assesses patient-specific barriers to communication including language preference and hearing and vision barriers Element 4B: Practice documents self-management support activities in the patient record Who will manage this standard? NCQA’s Example Sheet:- PPC 4 Must Pass Actions for Point Person Staff responsible Ready for NCQA The person assigned to do the final review Standard Complete NCQA document linked Points Completed Points Pending Upload completed Total Points A B X Notes: Element 4A: Documenting Communication Needs 2 Points The practice assesses patient/family-specific barriers to communication using a systematic process to: What is our current status? What needs to happen? Tools/ Resources needed Process
NCQA’s Example Sheet:- PPC 5 Must Pass Actions for Point Person Staff responsible for NCQA The person assigned to do the review Standard Complete NCQA document linked Points Completed Points Pending Upload completed Total Points A B C Notes: Element 5A: Electronic Prescription Writing 3 Points The practice uses an electronic system to prescriptions using either: Item What is our current status? Tools/ Resources needed Process Owner Due Date 1. Electronic prescription system (general) with either print capability at the office or ability to send fax or electronic message to pharmacy 75-100% of new prescriptions for patients seen in the last 3 months written using this system Practice has system capable of this but does not use it
What is our current status? What needs to happen? Tools/ Resources needed Process Owner Due Date 1. Tracks all laboratory ordered or done within the practice, until results are available to the clinician, flagging overdue results 2. Tracks all imaging ordered or done within the practice, until results are available to the clinician, flagging overdue results 3. abnormal test results, bringing them to a clinician’s attention 4. Follows up with patients/families for all abnormal test results 5. Follows-up with inpatient facility on hearing screening and metabolic screening to get results 6. Notifies patients/families of all normal test results. Data source Reports Examples Reports or logs—may be a log or an electronic in-box showing outstanding tests and showing how the practice flags abnormal results. Tools/ Resources Excel workbook for test, results and Paper test tracking log {} American College of Medical Genetics ACTsheets ( ) Percentage Min. score to pass Our score 100% Practice does 4 – 6 types of tracking and follow-up 75% No scoring option 50% Practice does 3 types of tracking and follow-up X 25% Practice’s electronic system has the capability to all 4 types of tracking and follow-up but practice does not use it 0% Practice’s system does not have capability to track, or the practice does fewer than 3 types of tracking and follow-up Examples/Notes: PCMH 6A1,3,4,6 – ( ) PCMH 6A1,3,4,6 – ( ) PCMH 6A1 – ( ) PCMH 6A2 – ( ) PCMH 6A3 – ( ) PCMH 6A4 – ( ) PCMH 6A6 – ( ) PCMH 6A – ( ) Element 6B: Electronic System for Managing Tests 6 Points
Import elements of their medical record into a personal health record. Yes No Website with HIPPA complaint communication function Reach My Doctor – “Basic Patient Communication” function Examples Screen shots showing presence of web-based functionality Resource If your practice have this functionality, sign up for ReachMyDoctor Basic Patient Communication by contacting . Percentage Min. to pass Our Score 100% Practice providers 5 – 6 items 75% Practice providers 3 – 4 items 50% Practice providers 1 – 2 items X 25% No scoring option 0% Practice does not any items Examples/Notes: PCMH 9A1 - ( ) PCMH 9A4 – ( ) Practice Brochure ( ) Element 9B: Electronic Patient Identification 2 Points The practice combines use of electronic information and clinical decision-support to contact the following of patients, once identified, by e-mail: What is our current status? Tools/ Resources needed Process Owner Due Date Patients needing clinical review or action Yes No Website with HIPPA complaint communication function My Doctor – “Premium Patient Communication” function Patients on a particular medication Yes No Website with HIPPA complaint communication function My Doctor – “Premium Patient Communication” function Patients needing preventive care Yes No Website with complaint communication function Reach My Doctor – “Premium Patient Communication” function Patients needing specific tests Yes No Website with HIPPA complaint communication function My Doctor – “Premium Patient Communication” function CareSpace Patients needing follow up visits Yes No Website with complaint communication function