Patient-Centered Specialt Practice Centered Specialty ... · PDF filePractices may submit an add-on survey, ... PCSP til J 1 2015 8 Patient-Centered Specialty Practice Recognition

Patient Centered Specialt Practice Patient-Centered Specialty Practice (PCSP) Recognition Program

Standards Workshop Part 12014

All materials © 2013, National Committee for Quality Assurance

Agenda Part 1C t t f PCSP St d d d G id li• Content of PCSP Standards and Guidelines– Standards 1 – 3

D t ti E l *– Documentation Examples*

Agenda Part 2• Content of PCSP Standards and Guidelines

– Standards 4 – 6– Documentation Examples*

*Examples in the presentation only illustrate the element intent. They are NOT definitive nor the only methods of documenting how the requirements may be met.

2Patient-Centered Specialty Practice Recognition Program

NCQA Resources Available

Free training each month http://www ncqa org/rptraining aspxhttp://www.ncqa.org/rptraining.aspx

• Getting On Board• Includes How to Submit as a Multi-siteIncludes How to Submit as a Multi site

• Standards (2 part program)

• Software Training• Using the ISS System for PCMH 2011 and PCSP• The Online Application• The Online Application


What Specialty Practices are Learning About Coordinated Patient-Centered CareCoordinated Patient Centered Care

Roadmap for quality

improvement using clinical performance

Roadmap for quality

improvement using clinical performance performance

measures performance

measures Enables

excellent care integration

with the

Enables excellent care

integration with the

Enhances coordination

between primary care and specialty

Enhances coordination

between primary care and specialty

medical homemedical homeand specialty

careand specialty

care

Aligns with processes that

improve quality and eliminate

Aligns with processes that

improve quality and eliminate

Improves the experience of

patients accessing

specialty care

Improves the experience of

patients accessing

specialty care wastewastePromotes

coordinated teamwork in an information rich

environment

Promotes coordinated

teamwork in an information rich

environment

specialty carespecialty care


environmentenvironment

PCSP Content and ScoringPCSP 1: Track and Coordinate Referrals Pts PCSP 4: Plan and Manage Care Pts

A. *Referral Process and AgreementsB. Referral Content C. *Referral Response

958

22

A. Care Planning and Support Self-CareB. *Medication ManagementC. Use Electronic Prescribing

11521822

PCSP 2: Provide Access and Communication

A Access

Pts PCSP 5: Track and Coordinate Care

A. Test Tracking and Follow-UpB. Referral Tracking and Follow-Up

Pts

565A. Access

B. Electronic Access C. Specialty Practice Responsibilities D. Culturally and Linguistically Appropriate

Services (CLAS) E *Th P ti T

5242

5

C. Coordinate Care Transitions 516

PCSP 6: Measure and Improve Performance

Pts

E. *The Practice Team 518

PCSP 3: Identify and Coordinate Patient Populations

Pts

A. Measure PerformanceB. Measure Patient/Family ExperienceC. *Implement and Demonstrate

Continuous Quality Improvement

554

A. Patient Information B. Clinical Data C. Coordinate Patient Populations

343

10

y pD. Report PerformanceE. Use Certified EHR Technology

20

16


10 100*Must Pass Elements

The PCSP Design Challenge• To accommodate the range of

relationships between PCP and specialist: p p– Consulting on patients– Evaluating and treating patientsg g p– Co-managing patients– Providing temporary/permanent care Providing temporary/permanent care

management for some patients– Patient self-referral

• Practices are likely to have patients in each relationship “category”


PCSP Scoring6 standards = 100 points

M t P El t

5 Must Pass elements

NOTE: Must Pass elements require a ≥ 50% performance level to pass

Level of Qualifying Points Must Pass Elementsat 50% Performance Level

Level 3 75 - 100 5 of 5Level 2 50 - 74 5 of 5Level 1 25 - 49 5 of 5

Not Recognized 0 - 24 < 5Not Recognized 0 24 < 5

Practices with a numeric score of 0 to 24 points and/or achieve less than 5 “Must Pass” Elements are not Recognized.

Recognition is for 3 years. Practices may submit an add-on survey, based on their initial survey, within the 3 year Recognition to achieve a higher level. After 3 years, the practice must submit the survey version available at that ti f l


time for renewal.

Meaningful Use of Health Information Technology (HIT)Information Technology (HIT)

• NCQA emphasizes HIT because helps manage informationmanage information

• Reinforces HIT use to improve qualitySt 1 d St 2 i f l • Stage 1 and Stage 2 meaningful use language are embedded in the standardsstandards

• Synergy: practices will be well prepared to qualify for meaningful use, and vice q y g ,versa

• Stage 2 measures will not be scored in PCSP til J 1 2015


gPCSP until Jan. 1, 2015

Eligible Applicants for PCSP Recognition

• Recognition is at the practice-site level • Assessment for Recognition must include a

survey for every site the practice expects to id tif R i d PCSP identify as a Recognized PCSP

• PCSP Recognition identifies clinicians ti i t th it i l di practicing at the site, including nurse

practitioners and physicians’ assistants who share or ha e their o n panel of patientsshare or have their own panel of patients

• Practice may add and remove clinicians for th d ti f th i R iti


the duration of their Recognition

Eligibility for PCSP Recognition

• May be multi-site and/or multi-specialty• May be multi-site and/or multi-specialty• Eligible clinicians:

MD DO– MDs, DOs– NPs/PAs with their own or shared panel of

patientspatients– Certified nurse mid-wives

B h i l h lth i li t P h l i t – Behavioral health specialists: Psychologists, licensed clinical social workers, marriage and family counselors


family counselors

PCSP 1: Track and Coordinate ReferralsIntent of Standard• Referral process that includes • Referral process that includes

agreements with primary care and a timely exchange of information timely exchange of information

• Primary care/referring clinician is informed of information the practice informed of information the practice needs to include in a referralS i lt ti id ti l • Specialty practice provides a timely referral response with test results and t t t d ti


treatment recommendations

PCSP 1: Track and Coordinate ReferralsCS : ac a d Coo d a e e e a s

Elements• PCSP 1A: Referral Process and

Agreements – MUST PASS• PCSP 1B: Referral ContentPCSP 1B: Referral Content• PCSP 1C: Referral Response – MUST PASS


PCSP 1A: Referral Process and Agreements The practice has a written process for implementing and managing referrals with PCPs/other referring clinicians 1. Formal and informal agreements2. Specified methods of communication with

PCP/referring clinicianPCP/referring clinician3. Specified method of communicating with the

patient/family/caregiverp / y/ g4. Specified co-management or transition strategy5. Confirmation of receipt and acceptance of referral6. Information needed from PCP about patients7. Information and timing of the referral response to PCPs8 C i i l d i /f il


8. Communicating results and treatment to patient/family

PCSP 1A: Referral Process and Agreements

• MUST PASS• 9 Points9 Points• Scoring

– 6-8 factors = 100% – 4-5 factors = 75%– 2-3 factors = 50%

N i ti 25%– No scoring options = 25%– 0-1 factors = 0%

• DocumentationDocumentation– F1-8: Documented process and– F1-8: Three examples showing process has been


implemented

PCSP 1A: Referral Request Checklist

Recommends:Recommends:

• Pt. demographics• Special issues• Insurance• Provider name/contactProvider name/contact• Urgency• Type of referral• Clinical question• Core clinical data• Key data – notes/tests• Pt. knowledge

American College of


American College of Physicians (ACP) Website

PCSP 1A: Example of a Referral Form

Referral Form Includes: D t• Date

• Referring clinician• Diagnosis• Weight

D f• Degree of urgency• Type of referral (consult, testing,

follow-up, consult and treat)• Patient contact

Appointment confirmation• Appointment confirmation • Test results sent to specialist• Notes


PCSP 1A: Sample Referral Agreement

Women’s Health and Family Medicine Collaborative

Services Agreementg

• Women’s health core services• Access agreements• Communication agreements

Q lit t• Quality assurance agreements• Family medicine core services


PCSP 1B: Referral ContentThe practice has a written process and monitors against it to ensure receipt of information needed in referrals from referring clinicians: in referrals from referring clinicians: 1. Clinical question 2 T f f l 2. Type of referral 3. Urgency of referral

i i4. Patient demographics5. Clinical information6. Current primary practice care plan, treatment,

test results and procedures


7. Communication with patient/family/caregiver

PCSP 1B: Referral Content5 P i t• 5 Points

• Scoring100% 5 7 factors – 100% 5-7 factors

– 75% - 3-4 factors– 50% - 1-2 factors – 25% - No scoring option– 0% - 0 factors

• Documentation– Factors 1-7: Documented process– Factors 1-7: Report demonstrating information provided

by referring clinicians based on at least 1 month of data. Tracking system for information received from referring


Tracking system for information received from referring clinicians

PCSP 1A: Referral Urgency


PCSP 1B: Example Referral Request

C G C C


Carol Greenlee, MD, FACP FACE Western Slope Endocrinology

PCSP 1C: Referral ResponseThe practice has a written process and monitors against it to ensure a timely response to PCPs, referring clinicians and patients that includes: 1. Tracking system for confirming receipt of

the referral and sending date and time of th i t t t th f i li i ithe appointment to the referring clinician.

2. Answer(s) to clinical question(s) in referral3. Diagnosis4. Procedures and test results (con’t)


( )

PCSP 1C: Referral Response

5. Recommended specialist’s plan of care, care management, patient education, secondary greferrals

6. Follow-up needed with specialist including further coordination

7. Tracking system for monitoring timeliness of referral response

8. Providing an electronic summary of care d t th id f th 50 record to another provider for more than 50

percent of referrals++/++ Stage 2 Core Meaningful Use Requirements


+ Stage 2 Core Meaningful Use Requirements++ Stage 1 Menu Meaningful Use Requirement

PCSP 1C: Referral Response • Must Pass• Must Pass• 8 Points• Scoring• Scoring

– 100% - 6-8 factors– 75% - 4-5 factors– 50% - 3 factors– 25% - 1-2 factors

0% 0 f t– 0% - 0 factors• Documentation

– Factors 1 7: Documented process for staff and– Factors 1-7: Documented process for staff and– Factor 1-7: Report from tracking system based 1 mo. data – Factor 8: Report with numerator, denominator and


percentage

PCSP 1C: Referral Response Example

Referral Response

• AcceptanceCh t f f l• Change type of referral

• Diagnosis• Secondary diagnosis• Medication changes

E i t h• Equipment changes• Diagnostic testing• Patient education• Procedures

S d f l• Secondary referrals• Follow-up• Special requests or

recommendations



Intent of Standard• Patients have access to

Meaningful Use• Patients provided Patients have access to

routine/urgent care and clinical advice that are

lt ll /li i ti ll

Patients provided electronic: – Access to health

i f ti culturally/linguistically appropriate during/after hours

information – Capability to download

health informationhours• Electronic access• Specified responsibilities

– Clinical summary of visit – Secure messaging

Specified responsibilities of specialist vs. PCP

• Team-based care;


trained staff


ElementsElements• 2A: Access• 2B: Electronic Access• 2B: Electronic Access• 2C: Specialty Practice Responsibilities• 2D: Culturally and Linguistically

Appropriate Services (CLAS) • 2E: The Practice Team– MUST PASS


PCSP 2A: AccessThe practice has a ritten process defined The practice has a written process, defined standards and demonstrates that it monitors performance against the standards to: performance against the standards to: 1. Provide patient appointments based on

patient need patient need 2. Provide same day appointments

i i i i i f i3. Provide non-visit consultations with referring clinicians

4. Provide timely clinical advice to patients who contact the office when the office is

( ’t)28Patient-Centered Specialty Practice Recognition Program

open (con’t)

PCSP 2A: AccessThe practice has a written process, defined standards and demonstrates that it monitors performance against the standards to: 5. Provide timely clinical advice to patients who

contact the office when the office is closed6. Document clinical advice to established

patients in the patient medical record7. Provide equal access to accepted patients

dl f f tregardless of source of payment8. Provide uninsured patients with information

b t bt i i 29Patient-Centered Specialty Practice Recognition Program

about obtaining coverage

PCSP 2A: Access• 5 Points• Scoring

100% 6 8 factors– 100% - 6-8 factors– 75% - 4-5 factors– 50% - 2-3 factors– 25% - 1 factors– 0% - 0 factors

• DocumentationDocumentation– Factors 1-8: Documented process for staff– Factors 1-6: Three examples of implementation

F t 7 M t i l id d t i d M di d – Factor 7: Materials provided to uninsured, Medicare and Medicaid patients showing non-discriminatory policy and a report with mix of payersF t 8 M t i l li k t t ti l i


– Factor 8: Materials or link to potential insurance sources

PCSP 2A: Example Access Policy

Types of Care Definitions/Policy:yp y• Routine Physical Exam• Routine Care• Urgent Care• Emergent Care• After-Hours Care• Office Waiting Time


PCSP 2A: Examples for Same Day Apptsp y pp


PCSP2A: Example Response Times to CallsShows:

Call date/timeCall date/time Response date/timeIf time meets policy


PCSP2A: Example Providing Timely Messaging Adviceg g

Clinical Call Response time for 5/7/2009 – 5/11/2009 (data attached)

Message Responders total # messages avg response time in hours:

Physicians 75 0.91

Residents 16 1.50

Midl l 24 0 89Midlevels 24 0.89

Nurses 73 0.94

Clinical Asst 62 1.03

Total 250 0 98 (standard is 2 hours)


Total 250 0.98 (standard is 2 hours)

PCSP2A: Example of Documentation of Call Response in Patient Recordp


PCSP 2A – Patient Access After Hours, Documented Process

ABC Plastic Surgery Effective 1/30/2012

Subject: After Hours Access for Patients- includes call response protocol- includes medical record access and documentation protocol

Patients have 24/7 access to a care provider outside of scheduled office hours. The on call provider is to have computer access while on call, which will enable that care provider access to patient records, to view and search patient records, and also record after hours activity for a patient, by logging onto the EMR remotely. After hours calls from patients are to be responded to by the on-call

id i hi h d i b d d d i i i iprovider within one hour and is to be recorded as a noted patient interaction in the EMR in within 24 hours of communication with the patient.


PCSP 2A – Patient Access After Hours, 5 Day Audit5 Day Audit

Date Person Calling

Call Time Who responds to patient

Time Response entered in Oxbow

Time to RespondCalling patient entered in Oxbow Respond

9/23/2011 Name of pt 7:22 pm Barbara 7:24 pm 2 min9/24/2011 Name of pt 8:44 am Barbara 8:46 am 2 min9/24/2011 N f t 8 59 B b 9 03 4 i9/24/2011 Name of pt 8:59 am Barbara 9:03 am 4 min9/24/2011 Name of pt 9:52 am Barbara 9:59 am 7 min9/25/2011 Name of pt 3:03 pm Barbara 3:10 pm 7 min9/25/2011 Name of pt 7:45 am Barbara 7:55 am 10 min9/25/2011 Name of pt 10:00 pm Barbara 10:10 pm 10 min9/26/2011 Name of pt 1:00 am Barbara 1:03 pm 3 min/ / p p9/26/2011 Name of pt 4:30 am Barbara 4:45 am 15 min9/26/2011 Name of pt 2:14 am Barbara 2:20 am 6 min9/27/2011 Name of pt 8:00 pm Barbara 8:02 pm 2 min


9/27/2011 Name of pt 8:00 pm Barbara 8:02 pm 2 min

PCSP 2B: Electronic AccessThe practice provides the following information and services to patients/families/caregivers through a secure electronic system1. More than 10/50 percent of patients have online access to their . o e a 0/50 pe ce o pa e s a e o e access o e

health information within four business days of when the information is available to the practice+

2. More than 5 percent of patients view, download or transmit to a p p ,third party their health information+

3. Clinical summaries are provided to patients, families/caregivers within 3/1 business day(s) for more than 50 percent of office visits+/ y( ) p

4. A secure message was sent to more than 5 percent of patients+5. Two-way communication between patients/families/caregivers

and the practice and the practice 6. Request for appointments, prescription refills and test results

+ Stage 1/2 Core Meaningful Use Requirements


NOTE: Factor 2 will be scored NA until 1/1/15

PCSP 2B: Electronic Access• 2 Points • Scoring

– 100% - 5-6 factors– 75% - 4 factors

50% 3 factors– 50% - 3 factors– 25% - 1-2 factors– 0% - 0 factors

• Documentation– Factors 1-4: Report based on numerator, denominator

d t f t 12 th ( 3 th ) f and percentage for a recent 12 months (or 3 months) of data in the electronic system

– Factors 5 and 6: Screen shots showing the capability of


the practice’s system

PCSP 2B: Example Interactive Web SiteHealth RecordDisease ManagementPrescription Renewal AppointmentsMessage CenterMessage Center


PCSP 2B: Example Interactive Website Requesting Appointment


PCSP 2B: Example Electronically Contacting Patient to Review Test Results


PCSP 2C: Specialty Practice ResponsibilitiesResponsibilities

The practice has a process and materials that it The practice has a process and materials that it provides to patients/families/caregivers about:1. Role of the specialist. o e o e spec a s2. Methods, content and frequency of

communication with the patient (e.g. test p ( gresults, care management, after-hours contact)

3. Coordination of care between the primary care clinician, the referring clinician, the

i li t d th ti t/f il / i43Patient-Centered Specialty Practice Recognition Program

specialist and the patient/family/caregiver

PCSP 2C: Specialty Practice Responsibilities

• 4 Points• Scoring

– 100% - 3 factors75% not a scoring option– 75% - not a scoring option

– 50% - 2 factors– 25% - 1 factor– 0% - 0 factors

• Documentation– Factors 1-3: Documented process– Factors 1-3: Materials such as brochures, Web materials

or letter to patients


p

PCSP 2C: Information for All Patients

Specialist


PCSP 2C Example Brochure

Our cardiologists will work hand-in-hand with your primary care physician to diagnose, treat and manage a wide variety of cardiac problems.


PCSP 2D: Culturally and Linguistically Appropriate Services (CLAS)Appropriate Services (CLAS)

The practice engages in activities to understand and meet the cultural and linguistic needs of its patients/families/caregivers1. Assessing the racial and ethnic diversity of its

population2 A i th l d f it l ti 2. Assessing the language needs of its population 3. Providing interpretation or bilingual services to

meet the lang age needs of its pop lation meet the language needs of its population 4. Providing printed materials in the languages of

its population 47Patient-Centered Specialty Practice Recognition Program

its population

PCSP 2D: Culturally and Linguistically Appropriate Services (CLAS)Appropriate Services (CLAS)

• 2 Points• ScoringScoring

– 100% - 4 factors– 75% - 3 factors

50% 2 factors– 50% - 2 factors– 25% - 1 factor– 0% - 0 factors

Doc mentation• Documentation– Factors 1 and 2: The practice provides a report showing practice

ethnic and language composition of its patientsFactor 3: Documentation of availability of interpretive services or has a – Factor 3: Documentation of availability of interpretive services or has a policy for using bilingual staff

– Factor 4: Provides or shows access to materials in languages needed by ≥5 percent of its population, including on-line materials to meet this


by ≥5 percent of its population, including on line materials to meet this requirement

PCSP 2D: Assessing the Diversityof the Populationp

Patients seen 5/1/2012 – 4/30/2013


PCSP 2D: Assessing the Language Needs of the Populationp

Patient Distribution by Language# of Patients % of Patients

English 2191 79.30% Spanish 0 0.00% Russian 2 0 07% Russian 2 0.07% Other 1 0.04% All other 0 0.00% Blank field 573 20 74% Blank field 573 20.74% Total 2763

This is based on unique pts seen between 08/07/09 -10/08/09. This sampling indicates that most of our patients speak English. We utilize staff sampling indicates that most of our patients speak English. We utilize staff that speak Spanish and also have available language line for any other languages that might be needed


PCSP 2D: Example of Providing Bilingual Servicesg g

LPN speaks Spanish


PCSP 2D Factor 4 Materials in Other LanguagesMaterials in Other Languages


PCSP 2E: The Practice Team 1. Defining roles for clinical and nonclinical team

members 2 Having regular team meetings or a structured 2. Having regular team meetings or a structured

communication process focused on patients3. Using standing orders for services4. Training and assigning care teams to coordinate care 5. Training and designating care team members in

i ti kill communication skills 6. Involving care team staff in the practice’s performance

evaluation and quality improvement activitiesevaluation and quality improvement activities7. Holding regular practice team meetings


PCSP 2E: The Practice Team

• 5 Points • MUST PASS

• Documentation– Factor 1, 4, 5: Staff position descriptions

of clinical team• Scoring– 100% - 5-7 factors

75% 4 factors

of clinical team– Factor 2: Description of structured

team communication on scheduled patients and three examples– 75% - 4 factors

– 50% - 3 factors– 25% - 1-2 factors

patients and three examples– Factor 3: Example of standing orders– Factors 4 and 5: Description or

i i i– 0% - 0 factors materials on training process – Factor 6: Description of staff roles in

practice evaluation/QI or highlighted i t f ti h i t ff minutes from meetings showing staff

involvement– Factor 7: Description of practice

ti d th l


meetings and three examples

PCSP 2E: Example of Care Team Members Responsibilities


PCSP 2E: Regular Team Meetings

Team huddles are one example pof regular team

meetings

Stewart EE Johnson BC Huddles: Improve Office Efficiency in Mere Minutes Family Practice Management


Stewart EE, Johnson BC. Huddles: Improve Office Efficiency in Mere Minutes. Family Practice Management Web site at www.aafp.org/fpm. Copyright© 2007 American Academy of Family Physicians.

PCSP 2E: Documentation Example


PCSP 2E: Example Standing OrdersPOLICY/STANDING ORDERS FOR ADMINISTERING PNEUMOCOCCAL VACCINES TO ADULTSPURPOSE: To reduce morbidity and mortality from pneumococcal disease by vaccinating all adults who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. POLICY: Under these standing orders eligible nurses/MOAs may vaccinate patients who meet anyPOLICY: Under these standing orders, eligible nurses/MOAs may vaccinate patients who meet any of the criteria below. PROCEDURE: 1. Identify eligible adults pneumococcal vaccination using the checklist in the nurse triage note: 2. Age > 65 3. Diabetes 4. Chronic heart disease 5. Chronic lung disease (asthma, emphysema, chronic bronchitis etc)

9. Sickle cell disease 10. Kidney disease (e.g. dialysis, renal failure, nephrotic syndrome) 11 Cancerchronic bronchitis, etc)

6. HIV or AIDS 7. Alcoholism 8. Liver cirrhosis

11. Cancer 12. Organ transplant 13. Damaged spleen or no spleen 14. Exposure to chemotherapy 15. Chronic steroid use 16. Exposure to radiation therapy

2. Screen all patients for contraindications and precautions to pneumococcal vaccine: a) Severe allergic reaction to past pneumococcal vaccine b) Pregnant patients (con’t)


(con t)

PCSP 2E: Example of Training Materials/DescriptionMaterials/Description

Care Team Training: Self-Management Support & Population ManagementManagement

Diabetes/Hypertension Care Team Training SessionsJoint Staff MeetingJoint Staff MeetingJune 3rd 2011 130-230Participants: All clinic staff and providers at general monthly clinic

meetingAgenda: The utilization of patient registries to manage high-risk

diabetics and hypertensive patients.diabetics and hypertensive patients.Summary:Introduction and education of patient care registries and their value


(con’t)

PCSP 3: Identify and Coordinate Patient PopulationsPopulations

Intent of the Standard Meaningful Use• Collect patient

information and li i l d t

g• Use electronic system to

collect patient d hi d clinical data

• Use data and evidence based

demographics and clinical data

• Generate lists of patients/ evidence-based guidelines to generate lists and remind

• Generate lists of patients/ remind patients of condition-related services

patients of care services needed

• Implement clinical decision-support i t ti


interventions

PCSP 3: Identify and Coordinate P ti t P l tiPatient Populations

• Elements• Elements• PCSP 3A: Patient Information

PCSP 3B Cli i l D t• PCSP 3B: Clinical Data• PCSP 3C: Coordinate Patient Populations


PCSP 3A: Patient InformationThe practice uses an electronic system that records the following as structured (searchable) data for more than 50/80 percent of the patients

1. Date of birth+ 2. Sex+

10. Presence of advance directives

11 H lth i i f ti

p

3. Race+ 4. Ethnicity+ 5. Preferred language+

11. Health insurance information12. Name/contact information of

primary care clinician g g6. Telephone numbers 7. E-mail address 8 Primary caregiver

13. Name/contact information of other specialists

14. Practice-patient relationship 8. Primary caregiver9. Occupation (NA for pediatric

practices)

status

+ Stage 1/2 Core Meaningful Use Requirement


+ Stage 1/2 Core Meaningful Use Requirement

PCSP 3A: Patient Information

• 3 PointsS i• Scoring– 100% - 10-14 factors– 75% - 8-9 factors – 50% - 5-7 factors– 25% - 3-4 factors – 0% 0 2 factors– 0% - 0-2 factors

• Documentation– Factors 1-12 - Report with numerator, denominator and

percentage with 12 months (or 3 months) of data– Factors 13 and 14 do not need to be searchable or structured

data. Documented process identifying how and where this


information is captured on patients and three examples

PCSP 3A: Example Patient Information

PCSP 3, Element A, Items 1-12 - Percentage of patients with documented items recorded as structured , , g p(searchable) data within the practice's EMR. The report is 12 months of data from May 4, 2011 to May 4, 2012

General Internal Medicine Associates

Total Patient Ethni Phone

Dates of Previous Legal Primary Insur

Count DOB Gender Race city Lang # Email Visitsg

Guardiany

Caregiver Adv Dir Info# of PTS 9904 9904 9904 9409 9409 9895 9748 3500 9904 NA NA NA 9541

% 100% 100% 100% 95% 95% 100% 98% 35% 100% NA NA NA 96%Correct Responses Yes Yes Yes Yes Yes Yes No Yes No No No Yes


PCSP 3A(1-5) - Demographics

Thi tifi d t d dThis certified system produced very graphic Meaningful Use reports that the were used to show practice level (all

id ) lt f 12 th

Demographic percentage for 1 year duration‐2/6/2011‐

providers) results for a 12 month reporting period

y / /2/6/2012.

Report covers all site providers.


PCSP 3A: Example

Sex

An acceptable summary report with at least 3 months of data with numerators, denominators and percentage over 50% for factors shown, explanation should i di t f d t i h bl t


indicate source of data as in a searchable system

PCSP 3B: Clinical DataThe practice uses an electronic system to record the following as structured (searchable) data.1. An up-to-date problem list with current and active diagnoses for

more than 80 percent of patients+2. Allergies, including medication allergies and adverse reactions for

more than 80 percent of patients+3. Blood pressure, with the date of update for more than 50/80

percent of patients 3 years and older+4. Height/length for more than 50/80 percent of patients+5. Weight for more than 50/80 percent of patients+6. System calculates and displays BMI (NA for pediatric practices)+6. System calculates and displays BMI (NA for pediatric practices)+7. System plots and displays growth charts (length/height, weight

and head circumference (less than 2 years of age)) and BMI percentile (2–21 years) (NA for adult practices)+ (con’t)


percentile (2 21 years) (NA for adult practices) (con t)

PCSP 3B: Clinical Data (cont.)The practice uses an electronic system to record the following as structured (searchable) data8. Status of tobacco use for patients 13 years and older for

more than 50/80 percent of patients+9. List of prescription medications with date of updates for 9. List of prescription medications with date of updates for

more than 80 percent of patients +10. More than 20 percent of patients have family health history

recorded as structured data+++recorded as structured data+++11. Enter at least one electronic progress note created, edited

and signed by an eligible professional for more than 30 t f ti t ith t l t ffi i it percent of patients with at least one office visit+++

+ Stage 1/2 Core Meaningful Use Requirement +++ Stage 2 Menu Meaningful Use Requirement


NOTE: Factors 10 and 11 will not be scored until 1/1/2015

PCSP 3B: Clinical Data

• 4 Points• Scoring• Scoring

– 100% - 9-11 factors– 75% - 7-8 factors– 75% - 7-8 factors– 50% - 5-6 factors– 25% - 3-4 factors– 0% - 0-2 factors

• DocumentationFactors 1-5, 8-11: Reports with a numerator, denominator and percentageF t 6 d 7 S h t


Factors 6 and 7: Screen shots

PCSP 3B: Example Clinical Data PCSP 3B Data for Practice 2 Primary Care Physicians

#1 PCP #2 PCP TotalN

Core Meaningful Use Requirements

Shows:C MU i tN

D

CO2 Y/N

N 18 66 84 95%D 22 66 88N

D

CO1

CO3 (factor 1)

CO4

Core MU requirements by physicianNCQA Factors by physician and total

D

N 22 66 88 100%D 22 66 88N 22 66 88 100%D 22 66 88N 22 64 86

CO6 (factor 2)

CO4

CO5 (factor 9)

D 22 66 88N 16 55 71 88%D 22 59 81N 17 20 37 63%D 17 42 59

CO10 Y/N

CO7

CO8 (factors 3‐7)

CO9 (factor 8)

CO11 Y/N

N

D

N 21 22 43D 22 66 88

CO14 Y/N

CO12

CO13


CO14 Y/N

CO15 Y/N

PCSP 3B: Example

Factor 1

Factor 9

Factor 8


PCSP 3B: Practice Data2 P i C Ph i i 2 Primary Care Physicians

1/1/2012-3/31/012Core MU Requirements (CO)

#1 PCP #2 PCP Total %CO3 (factor 1) N 18 66 84 95%

D 22 66 88D 22 66 88CO5 (factor 9) N 22 66 88 100%

D 22 66 88CO6 (factor 2) N 22 66 88 100%

D 22 66 88CO8 (factors 3-7) N 16 55 71 81%N 16 55 71 81%

D 22 66 88CO9 (factor 8) N 17 20 37 63%


D 17 42 59

PCSP 3B: Patients With Recorded Vital SignsClinician #1

255

Cli i i #2Clinician #2


PCSP 3C: Coordinate Patient PopulationsTh ti ti t i f ti li i l d t d The practice uses patient information, clinical data and evidence-based guidelines to: 1. Generate lists of patients and proactively remind 1. Generate lists of patients and proactively remind

patients/families/caregivers of services needed or coordinate with primary care for one condition-related service ++/+ service ++/+

2. Generate lists of patients and proactively remind patients/families/caregivers of services needed or p / / gcoordinate with primary care for a second condition-related service ++/+

3 Generate lists of patients and proacti el remind 3. Generate lists of patients and proactively remind patients/families/caregivers of services needed or coordinate with primary care for a third condition-


related service (con’t)

PCSP 3C: Coordinate Patient Populations

The practice uses patient information, clinical data and evidence-based guidelines to: g4. Generate lists of patients and proactively remind more

than 10 percent of patients/families/caregivers (or coordinate ith primar care for these patients) for coordinate with primary care for these patients) for needed preventive/follow-up care ++

5. Implement at least 1/5 clinical decision support p / ppintervention(s)+

+ Stage 1/2 Core Meaningful Use Requirement ++ Stage 2 Menu Meaningful Use Requirement++ Stage 2 Menu Meaningful Use Requirement

NOTE: Factor 5 requirement changes from at least 1 to at least 5 clinical decision support interventions as of 1/1/2015 to reflect the transition from


Stage 1 to Stage 2 MU

PCSP 3C: Coordinate Patient Populations

• 3 Points• Scoring

– 100% - 4-5 factors – 75% - 3 factors– 50% - 1-2 factors 50% 1 2 factors – 25% - No scoring option– 0% - 0 factors

D t ti• Documentation– Factors 1-4: Reports of patients managed by the specialist

needing services and follow-up – Factors 1-4: Materials showing how patients are notified of

needed services– Factor 5: Three examples of clinical decision support


p ppinterventions

PCSP 3C: Patients Needing Service

Patients havingPatients having abnormal BMI who need a

follow‐up plan.


PCSP 3C – Outreach for Service


PCSP 3C: Asthma Guidelines and UseAsthma Visit Sheet Shows:Physical exam specific torespiratory systemAll iAllergiesImmunizationsAsthma triggersPeak flowMedication tracking

Treatment planReferral

“National Asthma Education and Prevention Program (NAEPP) guidelines are imbedded in asthma visit sheet”


visit sheet

WE HAVE MOVED!• As of March 3 Submit Questions to our PCS System: • As of March 3 Submit Questions to our PCS System:

http://ncqa.force.com/pcs/login• You will need to register if you have never accessed g y

the system• Select “Recognition Programs” after logging in

A b b d Q&A t • A web-based Q&A system • Similar to what some know as PCS • Categorizes/lets you track your questionsCategorizes/lets you track your questions• Will help develop more useful FAQs and additional

documentationA l t id d t k FAQ• A place to provide and track FAQs

• No longer submit questions to [email protected]**Only submit if submitting payment or practice


O y sub sub g pay e o p ac ce changes**

NCQA Contact Information

Contact NCQA Customer Support: 1-888-275-7585 PCSP standards documents, application account, and survey toolsand survey toolsQuestions about your user ID, password, access

Visit NCQA Web Site: Visit NCQA Web Site: http://www.ncqa.org/Programs/Recognition/PatientCenteredSpecialtyPracticeRecognition.aspx

View Frequently Asked QuestionsView Frequently Asked QuestionsView Recognition Programs Training ScheduleView other Recognition Programs – PCMH, DRP, HSRP

Questions about interpretation of PCSP standards to: Submit a Question to PCS select “Recognition


gPrograms” after logging in.

Questions?Questions?


Documents

Patient-Centered Specialt Practice Centered Specialty ... · PDF filePractices may submit an add-on survey, ... PCSP til J 1 2015 8 Patient-Centered Specialty Practice Recognition