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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
3Patient-Centered Specialty Practice Recognition Program
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
4Patient-Centered Specialty Practice Recognition Program
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
5Patient-Centered Specialty Practice Recognition Program
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”
6Patient-Centered Specialty Practice Recognition Program
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
7Patient-Centered Specialty Practice Recognition Program
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
8Patient-Centered Specialty Practice Recognition Program
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
9Patient-Centered Specialty Practice Recognition Program
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
10Patient-Centered Specialty Practice Recognition Program
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
11Patient-Centered Specialty Practice Recognition Program
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
12Patient-Centered Specialty Practice Recognition Program
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
13Patient-Centered Specialty Practice Recognition Program
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
14Patient-Centered Specialty Practice Recognition Program
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
15Patient-Centered Specialty Practice Recognition Program
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
16Patient-Centered Specialty Practice Recognition Program
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
17Patient-Centered Specialty Practice Recognition Program
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
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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
19Patient-Centered Specialty Practice Recognition Program
Tracking system for information received from referring clinicians
PCSP 1A: Referral Urgency
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PCSP 1B: Example Referral Request
C G C C
21Patient-Centered Specialty Practice Recognition Program
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)
22Patient-Centered Specialty Practice Recognition Program
( )
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
23Patient-Centered Specialty Practice Recognition Program
+ 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
24Patient-Centered Specialty Practice Recognition Program
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
25Patient-Centered Specialty Practice Recognition Program
PCSP 2: Provide Access and Communication
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;
26Patient-Centered Specialty Practice Recognition Program
trained staff
PCSP 2: Provide Access and Communication
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
27Patient-Centered Specialty Practice Recognition Program
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
30Patient-Centered Specialty Practice Recognition Program
– 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
31Patient-Centered Specialty Practice Recognition Program
PCSP 2A: Examples for Same Day Apptsp y pp
32Patient-Centered Specialty Practice Recognition Program
PCSP2A: Example Response Times to CallsShows:
Call date/timeCall date/time Response date/timeIf time meets policy
33Patient-Centered Specialty Practice Recognition Program
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)
34Patient-Centered Specialty Practice Recognition Program
Total 250 0.98 (standard is 2 hours)
PCSP2A: Example of Documentation of Call Response in Patient Recordp
35Patient-Centered Specialty Practice Recognition Program
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.
36Patient-Centered Specialty Practice Recognition Program
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
37Patient-Centered Specialty Practice Recognition Program
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
38Patient-Centered Specialty Practice Recognition Program
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
39Patient-Centered Specialty Practice Recognition Program
the practice’s system
PCSP 2B: Example Interactive Web SiteHealth RecordDisease ManagementPrescription Renewal AppointmentsMessage CenterMessage Center
40Patient-Centered Specialty Practice Recognition Program
PCSP 2B: Example Interactive Website Requesting Appointment
41Patient-Centered Specialty Practice Recognition Program
PCSP 2B: Example Electronically Contacting Patient to Review Test Results
42Patient-Centered Specialty Practice Recognition Program
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
44Patient-Centered Specialty Practice Recognition Program
p
PCSP 2C: Information for All Patients
Specialist
45Patient-Centered Specialty Practice Recognition Program
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.
46Patient-Centered Specialty Practice Recognition Program
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
48Patient-Centered Specialty Practice Recognition Program
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
49Patient-Centered Specialty Practice Recognition Program
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
50Patient-Centered Specialty Practice Recognition Program
PCSP 2D: Example of Providing Bilingual Servicesg g
LPN speaks Spanish
51Patient-Centered Specialty Practice Recognition Program
PCSP 2D Factor 4 Materials in Other LanguagesMaterials in Other Languages
52Patient-Centered Specialty Practice Recognition Program
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
53Patient-Centered Specialty Practice Recognition Program
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
54Patient-Centered Specialty Practice Recognition Program
meetings and three examples
PCSP 2E: Example of Care Team Members Responsibilities
55Patient-Centered Specialty Practice Recognition Program
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
56Patient-Centered Specialty Practice Recognition Program
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
57Patient-Centered Specialty Practice Recognition Program
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)
58Patient-Centered Specialty Practice Recognition Program
(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
59Patient-Centered Specialty Practice Recognition Program
(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
60Patient-Centered Specialty Practice Recognition Program
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
61Patient-Centered Specialty Practice Recognition Program
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
62Patient-Centered Specialty Practice Recognition Program
+ 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
63Patient-Centered Specialty Practice Recognition Program
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
64Patient-Centered Specialty Practice Recognition Program
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.
65Patient-Centered Specialty Practice Recognition Program
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
66Patient-Centered Specialty Practice Recognition Program
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)
67Patient-Centered Specialty Practice Recognition Program
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
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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
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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
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CO14 Y/N
CO15 Y/N
PCSP 3B: Example
Factor 1
Factor 9
Factor 8
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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%
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D 17 42 59
PCSP 3B: Patients With Recorded Vital SignsClinician #1
255
Cli i i #2Clinician #2
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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-
74Patient-Centered Specialty Practice Recognition Program
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
75Patient-Centered Specialty Practice Recognition Program
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
76Patient-Centered Specialty Practice Recognition Program
p ppinterventions
PCSP 3C: Patients Needing Service
Patients havingPatients having abnormal BMI who need a
follow‐up plan.
77Patient-Centered Specialty Practice Recognition Program
PCSP 3C – Outreach for Service
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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”
79Patient-Centered Specialty Practice Recognition Program
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
80Patient-Centered Specialty Practice Recognition Program
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
81Patient-Centered Specialty Practice Recognition Program
gPrograms” after logging in.
Questions?Questions?
82Patient-Centered Specialty Practice Recognition Program