PCMH 2011 Application & Survey Tool, Chart Review, Documentation

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Merilyn Walters
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1 PCMH 2011 Application & Survey Tool, Chart Review, Documentation

2 PCMH Learning Community Project Structure Assessment, Gap Analysis, Workplan Webinar Series Group Technical Assistance Learning Sessions (Face to Face)

3 Patient Centered Medical Home 2011 Standards

4 NCQA s PCMH 2011 Process - Application - Multi-site - Survey Tool - Chart Review - Documentation

5 NCQA PCMH Standards & Guidelines

6 NCQA PCMH 2011 Application

7 PCMH 2011 Application 2&pf_id=

8 PCMH 2011 Application

9 PCMH 2011 Application

10 PCMH 2011 Application

11 PCMH 2011 Application

12 PCMH 2011 Application

13 PCMH 2011 Application

14 PCMH 2011 Application

15 PCMH 2011 Application

16 PCMH 2011 Application

17 NCQA PCMH 2011 Online Survey Tool

18 PCMH 2011 Online Survey Tool

19 Click on I Accept PCMH 2011 Online Survey Tool

20 PCMH 2011 Online Survey Tool Click on appropriate tool

21 PCMH 2011 Online Survey Tool

22 PCMH 2011 Online Survey Tool

23 PCMH 2011 Online Survey Tool Proceed to go into any of the standards you choose by clicking on the red lettering

24 PCMH 2011 Online Survey Tool Enter a response for each factor Each question must be answered

26 PCMH 2011 Online Survey Tool This screen will appear

27 PCMH 2011 Online Survey Tool

28 PCMH 2011 Online Survey Tool

29 PCMH 2011 Online Survey Tool Important Utility Tabs

30 PCMH 2011 Online Survey Tool This screen will appear

31 PCMH 2011 Online Survey Tool

32 NCQA PCMH Record Review Workbook

33 PCMH Record Review Workbook Two Methods for Elements 3C, 3D, & 4A Method 1. Query your electronic medical records or other electronic patient records to obtain the information for the important conditions identified in PCMH 3: Elements A and the high-risk or complex patients identified in PCMH 3: Element B to calculate the percentage directly. If you can use Method 1 (above) to respond to these elements, you can enter the responses directly into the Survey Tool and you do not need to use this Record Review Workbook. Method 2. Review a sample of 48 patient records to obtain the information. (Note: Patient records may be a registry or electronic records or paper medical records.) Refer to each element in the PCMH 2011 standards for details about scoring PCMH 3C, 3D, and 4A. If you cannot use Method 1, you must use Method 2 to respond to these elements and must fill out the Patient Conditions and Record Review Worksheets. You may respond to some elements with Method 1 and others with Method 2.

34 PCMH Record Review Workbook Selecting Conditions and Requisite # s Number of Patients Select the 48 patients who have any one or more of the three chosen clinically important conditions and who had a care visit related to the selected important conditions. These will be the patients used in your medical record review. You will review these same 48 patient files for all of the elements in this Record Review Workbook. Each of the three important conditions and the high-risk or complex patients must be equally represented. There must always be a total of 48 patients. * 4 Conditions: If the practice identified high-risk patients in 3B, these patients should be included in the Workbook in addition to the 3 important conditions identified in 3A. There must be 12 patients from each of the 3 important conditions plus 12 high risk patients. * 3 Conditions: The important conditions should have an equal number of patients. There must be 16 patients which may be three conditions identified in 3A OR two important conditions identified in 3A (including one unhealthy behaviors or substance abuse or mental health condition) plus the high-risk or complex patients identified in 3B. * 2 Conditions: If the practice chooses only two important conditions in 3A (including one unhealthy behavior or substance abuse or mental health condition), 24 patients must be used for each important condition.

35 PCMH Record Review Workbook 48 Patients Evenly divided among 3 conditions + High Risk Group or Evenly divided among 3 conditions Has to be based off of scheduled patients close to submission date

36 PCMH Record Review Workbook

37 PCMH Record Review Workbook

38 PCMH Record Review Workbook

39 PCMH Standard 3 Element C Factor 2 Care plans w/ goals that are reviewed and updated

40 PCMH Record Review Workbook Yes Yes Yes

41 Developing Documentation

42 Developing Documentation Detailed, appropriate screenshots and policies Annotated with explanations Arrows and circles to highlight what piece of evidence is referred Omitted Protected Health Information (PHI)

43 Developing Documentation Specific explanation of how this aspect of the screenshot meets the factor

44 Organizing Documentation Shared drive folder to avoid numerous versions on various computers Name files to associate with standard Add final to the file name if final If using web based sharing (DropBox), HIPAA

45 Organizing Documentation

46 Organizing Documentation

47 Resources NCQA PCMH 2011 Recognition Process (PDF) 43FY%3d&tabid=631&mid=2435&forcedownload=true NCQA 2011 PCMH and CAPHS PCMH Application Order NCQA 2011 Survey Tool Order

48 Upcoming Dates September 6 th Webinar 7: PCMH Standard 4 October 25 th Learning Session Must-pass Elements EMR Alignment Challenges and Barriers to Practice Transformation Group Technical Assistance August 3 rd, :00 AM August 9 th, :00 PM

NCQA Standards Workshop Patient-Centered Medical Home PCMH 2011. Part 1: Standards 1-3

NCQA Standards Workshop Patient-Centered Medical Home PCMH 2011. Part 1: Standards 1-3 NCQA Standards Workshop PCMH 2011 Part 1: Standards 1-3 Agenda: Part 1 Overview Content of PCMH 2011 Standards 1 3 Documentation examples* * Examples in the presentation only illustrate the element intent.