NCQA PCMH 2017

Recognition Process

In the 2017 PCMH Standards, practices must pass all 40 core criteria and at least 25 credits from the available 61 Elective Criteria (worth between 1-3 credits each/84 credits are available) which should span 5 of the 6 Concepts areas. Here are the Concepts:

The initial recognition process takes approximately 12 months to complete. During the 12-month period, practices participate in three Virtual Reviews with an NCQA Manager. Prior to each Virtual Review, the practices will upload documentation to NCQA’s online program called QPASS. The practice, the NCQA Manager, and assigned PCMH Certified Content Expert(s) will have access to review the information in QPASS. Once the Virtual Review is scheduled, the NCQA Manager will review the material the practice loads in QPASS. During the Virtual Review (WebEx/Skype Business Call) with the practice, the NCQA Manager may ask the practice to expound upon specific processes and/or show the NCQA Manager an example of a workflow in a real patient’s chart. In some cases, the NCQA Manager will ask the practice to adjust workflows and/or provide new evidence for the next Virtual Review. This process allows the practices to get real-time feedback from the team at NCQA, and it also allows the NCQA team to mark off completed criteria. Significantly, this method has helped shorten the time between the final review and the practice being awarded recognition to around 4-6 weeks.

Older versions of the NCQA’s PCMH Recognition Program awarded practices that met the standards with three levels of recognition. Practices that completed a little more than the six “Must Pass” criteria achieved Level 1, while practices that completed nearly all the criteria were awarded the highest Level 3 recognition. This led to a vast difference between Level 1 and Level 3 practices which was evident in the literature. As a result, NCQA changed the requirements from 6 “Must Pass Elements” to “40 Core Criteria” and they removed the levels of recognition and replaced it with a simple recognized or not recognized status. By dramatically increasing the number of required measures, NCQA is able to provide a higher level of confidence in practices that have achieved the 2017 recognition, and the payers can count on these practices to drive results.

Likewise, previous versions of the application allowed practices to maintain their recognition for a three-year period before submitting evidence that the organization was maintaining the workflows that were validated in their original application. This process often led to practices “falling off the wagon” for two years post-recognition and then scrambling to reimplement workflows in year three.

Annual Reporting

Today, once recognized, a practice has an expiration date (one year after the recognition date). One month prior to the practice’s expiration date, the practice is required to submit an Annual Report which demonstrates their ongoing commitment to meeting NCQA’s standards. This Annual Report includes many of the Core Criteria with a special focus on driving quality improvement. By making these changes, NCQA not only ensures that recognized practices are meeting the highest standards but also that they maintain this level of performance over time.  For more information click here.

Multi-Site Application

Groups who have three or more practice sites that share some of the same processes, the same EMR, and the same leadership are eligible to streamline the recognition process by submitting policies and evidence once for multiple sites for selected criteria.

Pre-Validation Program

Additionally, practices that utilize NCQA “Pre-validated” IT vendors (typically EMRs or Registries) are eligible to receive auto-credit for some of the criteria if the practice has implemented specific workflows.  For more information click here.

NCQA Fees

NCQA charges a multi-site and per provider per site fee for the initial recognition and a per provider fee annually for Annual Reporting in order to maintain recognition.  For more information click here.