No. The performance goal must be quantified (e.g., a number or percentage signifying a specific performance level).
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5.29.2018 QI 08 May “improve performance” be a stated performance goal?
5.29.2018 CC 08 Our practice is part of an integrated health system. Do we need to show agreements between primary care providers and specialists?
Yes. Practices must have an agreement or documented process outlining the responsibilities of the referring provider and the specialist, even in an integrated system. It is essential that each provider understands the expectations and responsibilities of the referral, including the frequency and methods of communication.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 14 Are practices required to show they can identify all patients who have been admitted to the hospital and treated in the ED?
No. Practices are not required to identify all patients admitted to the hospital or ED, but they must have a process for identifying patients admitted to facilities used most often by their population. In addition to a documented process, practices must also submit a log or report demonstrating that patients were identified.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 04C Our PCPs and specialists use the same integrated EHR. Do we need to show tracking and follow-up?
Yes. Practices that use integrated systems must demonstrate how specialists are notified of a referral request and how the referral status will be tracked (including the specialist’s report). Even if the same EHR is used by both the primary care practitioner and the specialist, evidence must clearly demonstrate how the requirements are met within the system.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 08 Are practices required to only refer to specialists with whom they have agreements, or is the requirement that an agreement be in place? Give an example of an agreement.
Practices are not restricted to referring patients only to practices with whom they have established agreements. NCQA reviews at least one example of a formal or informal agreement with a subset of specialists, but does not expect practices to have agreements with all specialists to whom they refer patients. The goal is that expectations are outlined in the agreement, in addition to expectations of timeliness/content of response from specialists.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 01 What is the minimal information required to meet the requirements of the laboratory and radiology items outlined in CC 01?
There is no minimum data requirement. To meet this core requirement, practices must meet all six items outlined in CC 01. Practices must consider how best to demonstrate their process for each item to meet the intent as described in the guidance section of this criterion.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CC 10 (PP 04) Our practice has agreements with and shares patient records with behavioral healthcare providers, but we do not share the same EHR or physical location. Do we meet the requirement for integrating behavioral healthcare in our practice?
No. Although there is no requirement for a behavioral healthcare provider to be physically in the practice’s office, the behavioral healthcare provider must have at least partial access to the practice’s systems. Although the arrangements mentioned meet the intent of CC 09 (maintaining agreements with behavioral healthcare providers), they do not meet the requirements for this criterion.
If a practice site in an organization has integrated behavioral healthcare, the other sites in the organization may receive credit if there is also a process for their patients to access those behavioral healthcare services.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CM 05 May practices make the individualized care plan available via patient portal, or are they required to provide the document in writing?
Although the care plan can be made available via the patient portal, it is essential that all patients have access to the document. If patients are not registered for the portal, they will not have access. In those cases, practices should use an alternative method to provide the written care plan to patients to ensure that all patients have access after an appointment. Please note practices must document that the care plan is provided to the patient in the patient’s medical record.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CM 07 Are practices required to document that they assess and address patient barriers to meeting treatment goals?
Yes. Practices must assess whether there are barriers to meeting goals and should address any identified barriers. Both components must be listed in the medical record in order to select “Yes” in the Record Review Workbook. If the practice assesses potential barriers and none are identified, the practice may answer “Yes.”
Note: Practices must provide an example of how they meet each criterion and complete the Record Review Workbook. Examples are not required if a practice provides a report as evidence.
This applies to the following Programs and Years:
PCMH 20175.29.2018 CM 04 Does a clinical summary meet the requirement for a “plan of care”?
If the clinical summary also includes the details of the patient’s care plan (i.e., information outlined in the criterion guidance), then it would meet the requirement. A clinical summary alone that does not include the patient’s care plan information would not meet the requirement.
