New medical home standards stress care coordination

Washington -- New medical home standards released by the National Committee for Quality Assurance on Jan. 31 place greater emphasis on patient feedback, access to physicians and care coordination.

NCQA, a nonprofit health-care quality organization based in Washington, D.C., began formulating the update not long after releasing its original medical home standards in January 2008.

More than 7,600 clinicians and 1,500 sites have been recognized by NCQA as patient-centered medical homes, with the vast majority achieving the status in 2010.

Each site or clinician is ranked from level 1 to 3 based on the number of standards met, with level 3 being the highest level.

NCQA revised its patient-centered medical home program after consulting with certified sites and their clinicians, surveying patients and the public, and analyzing program data, said Lee Partridge, a member of an NCQA advisory panel and a senior health policy adviser for the National Partnership for Women and Families.

Language in NCQA's 2011 medical home standards puts them in alignment with federal meaningful use standards for adopting electronic medical records.

The NCQA program also contains new standards for after-hours patient access, and for communication between a physician or clinic and patients over the phone and by e-mail, said Johann Chanin, NCQA director of product development.

"There are some aspects of access and communication that we didn't include this time, so we zeroed in on whether a patient is able to gain access to care during and after hours," she said.

Although most sites and clinicians probably already meet some of the medical home standards, achieving official recognition will be somewhat more difficult, Chanin said. Documenting that the standards have been met can take several months or longer and cost $500 to $3,000, according to NCQA.

Pilot programs and other incentives available in certain parts of the country can help defray the cost.

Practices with electronic medical records systems will have a head start because that's the costliest part of becoming a medical home, Chanin said. Medical home recognition lasts three years.

New York is a leader in medical home recognition. More than 200 sites and 200 clinicians had received NQCA medical home recognition by the end of 2010, in part because the state's Medicaid program offers incentive pay to physicians and clinics that achieve the certification. The amount of pay increases with the level of recognition.

Quality a key

Federal health policymakers increasingly are discussing the need to improve the quality of care in Medicare and Medicaid.

Better care coordination and greater efforts to listen to patients are keys to reducing unnecessary health spending and improving patient outcomes, said Centers for Medicare & Medicaid Services Administrator Donald M. Berwick, MD. He spoke Jan. 27 at a conference for health care consumer advocates in Washington, D.C. "Lower cost has got to be part of the agenda. But the only acceptable route there is through the improvement of quality," he said.

Peter McDougall, MD, a solo family physician in Fort Worth, Texas, has been recognized as a level 3 NCQA medical home since March 2010. He was in a good position to receive recognition because he's had an EMR system since 1997. Staff members enter data during patient visits and follow up with patients.

Dr. McDougall spent about $8,000 and several months in 2010 to receive the certification. He said his patients gave him a lot of positive feedback about the achievement. Most NCQA standards make a lot of sense, he said.

Dr. McDougall said doctors should look at NCQA recognition as a reward in itself, not a fast track to better payment. "If your goal is to increase payment by recognition, I think that's way in the future and very cloudy," he said. "I know the payers quite well. They really don't have a good feel at all for what this process is."

Seeking NCQA medical home recognition was a natural extension of Group Health Cooperative's ongoing efforts to improve the quality and efficiency of health care, said the cooperative's spokesman, Mike Foley. The Seattle-based health care organization provides coverage to 650,000 people in 20 counties in Washington and two in Idaho. Two-thirds of its members receive care in the 26 medical clinics it owns.

NCQA recognized all of Group Health's medical clinics as medical homes in October 2010. The organization pursued the recognition in part to enhance its brand, but also because it fit in with its goals of improving quality of care and reducing costs, Foley said.

Group Health encourages its doctors to communicate with patients on the phone and through e-mail. That reduces the need for patient visits, which allows doctors to spend more time with other patients, Foley said.

"Our financial incentives are different because we're a health plan," he said. "We save money if someone doesn't go to the hospital. If we can take good care of somebody with diabetes or heart disease, we can save money."

Group Health plans to renew its NCQA medical home recognition when it expires in 2013, said Terry Aoki, the organization's manager of quality performance review.