Six Key Steps to Achieving PCMH Recognition

There are many perks to getting your practice the PCMH – Patient-Centered Medical Home – designation. The service delivery model of a PCMH practice is inclusive and comprehensive, improving the reputation of your clinic or office, which brings more patients through the door. Plus, for practices that fully adopted integrated care services, i.e., behavioral health and physical health services, the effectiveness of this approach will enable the practice to increase revenue because you are accurately identifying patients at highest risk for adverse outcomes, due to social and/or emotional needs and mitigating these from happening. In some instances, payers incentivize PCMH providers with “Pay for Performance” compensation, clinical quality performance-based awards. Everyone wins: patients get great care, the neediest patients get more intensive monitoring and services to keep them healthier longer, the insurance companies see patient outcomes improve, and your practice can become more successful.

What does it take to get that coveted PCMH recognition? Here are the basic steps, as recommended by Deborah Johnson Ingram, PCDC’s Senior Director of the PCMH facilitation team.

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1. Don’t Try To “Eat the Whale”

The standards for getting PCMH are intense, but don’t look at that first. That would be like trying to “eat the whale.” First, recognize that you probably already do many of the processes needed for you to meet the requirements—otherwise, you most likely would not be looking to get PCMH designation. Take a deep breath, and realize that being a quality primary care provider, you’re likely more than half way there in meeting the PCMH rules.

2. It’s Just The Six “Buckets”

There are six major buckets that you will need to demonstrate for the PCMH recognition process. Look at these six areas of your practice: Team-Based Care and Practice Organization, Knowing and Managing Your Patients, Patient-Centered Access and Continuity, Care Management and Support, Care Coordination and Care Transitions and Performance Measurement and Quality Improvement. Most practices perform these activities daily, but for PCMH you’ll have to formalize your workflow with documented (written and dated) policies and procedures.

3. Do Robust Patient Surveys

To help you assess how you are doing on the six areas needed to qualify for PCMH Recognition, do patient surveys. I mean it is called patient centered! There are many evidence-based patient experience/satisfaction survey questions out there, so you don’t need to reinvent the wheel. Be open-minded as you assess the results. You may feel that you are serving your patients well, but there may be some hidden issues or disconnect that you never thought to ask about. For instance, if another family member does not have access to health care for any reason is your patient splitting their medication with that family member instead of taking the full dose? Can your working patients get time off during the hours you are open to make an appointment, or should you adjust your hours? Surveys help you identify opportunities for improvement.

4. Analyze the Gaps and Spread the Work

Look at what you are doing and compare it to the requirements for PCMH. You may well find that you are meeting the requirements, or at least close, in many areas. But you may need to begin monitoring that PCMH activities are getting completed to show that you are compliant with the PCMH rules. Engage your staff to garner their ideas to monitor compliance. You may need to write better job descriptions for your staff, so they know they need to make follow-up calls to check in on some of your high-risk patients. Making your practice compliant doesn’t mean that the physicians themselves have to do a bunch of extra work themselves. Developing systems and processes in your office to make sure the boxes for PCMH compliance get checked means your whole staff can help with compliance.

5. Train Your Staff

Once you know where your gaps are, you can train the appropriate staff to help you meet the rules. This is also a time to get buy-in from staff who may worry about adding to their workloads. In most cases, better processes will make the work easier and more satisfying, as patients will be better managed and have better outcomes. Make sure you explain the benefits of the new tasks, so staff members understand the reasons for the changes. Everyone, including the practitioners, need to know how to properly document the steps they are taking in your EMR system to provide the ongoing documentation of your work to be a PCMH.

6. Build Infrastructure for Sustainability

You will need to continue all the processes that you put in place to get the PCMH designation, and a solid structure will help you sustain these practices going into the future. Document the processes, both in job descriptions and in your workplace manuals. In addition, plan for periodic re-assessments of your processes to make sure they remain compliant with PCMH standards. Include the updating of your documentation and systems to meet the changing needs of your practice and include your entire care team in the process.

To get qualified for PCMH is a process, but taking it step-by-step makes it easier to achieve. Don’t get overwhelmed by how big the project looks from the outset. If your facility is interested in participating in the PCMH program, it is likely that much of what you already do will bring you close to compliance with the rules. Plus, if there are some gaps in your systems, going through the process of getting your designation will help you fill in what you are missing, making your practice stronger and more effective in serving your patients. PCMH approval is a worthy goal for practices seeking to better serve their communities.