Deciding on a Recognition Program

Deciding on a Recognition Program

Before pursuing PCMH recognition, SBHC practitioners must assess their readiness. When deciding which options are best for your SBHC, ask the following questions:

  • Is staff willing to commit to the process?
  • Has the electronic health record been functioning at least six months prior to initiating the process?
  • Is PCMH recognition a requirement of payers, regulatory agencies, and/or managed care organizations in my state for reimbursement, certification or licensure, or as an element of participation agreements?
  • Does the SBHC medical sponsor already have or is in the process of pursuing PCMH recognition for its community clinics? If so, have they considered including the SBHC(s) in that process?
  • Will the SBHC qualify for higher reimbursements or enhanced payments from Medicaid or other payer for PCMH recognition and, if so, is there a particular PCMH recognition process required?
  • Is the SBHC already accredited by JC or AAAHC and therefore familiar with the process?  Receiving PCMH recognition through that same organization would then be an add-on to that process.
  • What is the cost versus benefit of the recognition process and is there financial support for pursuing it? As mentioned above, HRSA financially supports FQHCs in obtaining recognition.
Click here to see comparison of the three national PCMH recognition processes. Dimensions include: cost, scope, eligibility, documentation, recognition requirements, levels of certification, and cycle.

 

Table 1: Comparison of National PCMH Recognition Processes
DimensionNCQAAAHCJoint Commission
Cost$630 survey tool license fee & application fee for 1 clinician. The fee increases based on number of clinicians$5000-$7000 for a single site, more for organizations with multiple sites$300/year for 3 years PLUS accreditation costs, (from $9,000 to >$35,000 over 3 years depending on # of sites)
ScopeIndividual practice siteEntire organizationEntire organization
EligibilityPrimary care provider, (MD or APRN if independent provider), is PCMH for majority of clientsMD, APRN, or PA directed servicesProvide primary care services established in standards and serve at least 10 patients, 2 active patients
ProcessWeb-based survey tool is completed. Supporting documentation that validates responses must also be submitted online. Documentation includes written statements that describe policies and procedures, aggregated data reports, patient files or registry entries, and materials provided to patients. NCQA reviews the documentation and scores the factors within 60 days of receiving it. Sites must receive a passing score on the six must pass elements and receive a minimum score of 35 to be recognized. Submission of application & supporting documentation followed by onsite survey within 6 months.
Peer reviewers provide consultative support before, during, and after the visit. Length of visit and number of surveyors depends on number of sites being certified, distance between sites.
Reviewers assess documents onsite and query staff. Summation conference convened to present, discuss, and clarify findings.
AAAHC staff and accreditation committee review information provided by organization and peer reviewers; make a decision regarding certification.
Submission of online application followed by onsite survey by JC team within 1 year.
Technical support is provided to applicant, including tools and sample survey agenda to help prepare for site survey.
Survey process includes onsite observations and staff interviews, documentation review, facility assessment, patient interviews and patient-provider observation.
Unannounced site visit 18-30 months after initial visit.
Accreditation
required?
NoNoYes
Levels3 levels based on scoreNo levels – Certification may include a plan for improvementNo levels
Recognition Cycle3 years3 years3 years

 

NCQA PCMH Recognition Program
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