Skip to main content

Are you aware of the most recent Patient-Centered Medical Home updates?

The National Committee for Quality Assurance (NCQA) releases updates annually to the Patient-Centered Medical Home (PCMH) Standards and Guidelines. Any primary care practice, whether first transforming to achieve PCMH recognition, or a practice seeking to maintain recognition, must implement and demonstrate the core criteria of the PCMH standards and guidelines.

NCQA has added numerous elective criteria for practices to pursue to ensure they have an adequate amount of credits to achieve recognition between the mandatory core and elective criteria available. Practices should visit the NCQA website for the latest version (v8) of the standards and guidelines, released on July 1, 2022.

Health equity

An update made this year is to best align with the Health Equity Accreditation/Plus program offered by NCQA. Also, in response to lessons learned from the COVID-19 pandemic, PCMHs should be positioned to understand what vulnerabilities and social determinants may impact their patients' overall wellbeing.  Practices are being asked as a core criterion to collect from all patients:

  • race,
  • ethnicity,  
  • sexual orientation and gender identity, and
  • an additional measure of diversity, applicable to the panels they serve.

National benchmarks

Another key change to consider is for NCQA to provide national benchmarks to practices that report on clinical quality measures. Having standardized measures and reporting periods would assist in promoting this mission. Practices are being granted the ability to continue using customized measures and reporting periods for 2023, allowing more time to ready their quality reporting programs to rely on strictly standardized measures/eCQMs with set date ranges of the previous year. This will be made mandatory for practices seeking recognition in 2024.

Annual reporting requirements

Along with changes to the PCMH Standards and Guidelines, NCQA has also released their annual reporting requirements for 2023. Each year, sites are held accountable for sustaining their PCMH by demonstrating specific pieces of documentation, evidence, or reports from the program. The requirements change each year, so it is extremely important to keep all foundational processes and documentation of the medical home integrated into all daily practice operations.

Besides reporting annually, audits do randomly occur to 5% of all PCMH recognized practices. Practices should visit the NCQA website of to download the latest version PCMH Annual Reporting Requirements which were released on July 1, 2022.

New requests of the Annual Reporting Requirements for 2023 (but not foreign to the medical home) are a focus on access provided to patients outside of regular business hours, demonstrated in report format. Also, practices reporting in 2023 will be asked to show their panel breakdown by race, ethnicity, and third measure of diversity. Optionally, NCQA asks sites to show gender identity and sexual orientation, which align with the changes to the PCMH Standards and Guidelines that all sites should execute.

DataGen’s Practice Advancement Strategies has been working with practices nationally for more than 10 years. We pride ourselves on being a trusted advisor, ensuring you achieve NCQA recognition or accreditation. If you are seeking PCMH recognition, or want to maintain your PCMH recognition, please contact Mandi Diamond today at (631) 626-1062.


Popular posts from this blog

BPCI Advanced – take advantage of the model extension now

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit

You’ve been accepted to the Enhancing Oncology Model. Now what?

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic le

3 Major Areas to Focus on After Receiving NCQA PCMH Recognition

First off, congratulations to you and your practice for achieving National Committee for Quality Assurance Patient-Centered Medical Home recognition! Gaining NCQA PCMH status is a big accomplishment for which you should be very proud. Now that you’ve completed the necessary steps to implement changes and earn recognition, you may be wondering what’s next. In this guide, we’ll navigate what to do next, PCMH standards and guidelines to follow and 2024 annual reporting requirements to focus on. Let’s get into it! What to do after earning NCQA PCMH recognition Before you’re ready to start earning the great benefits of PCMH recognition , you need to plan what actions you’ll take to maintain your status. Remember, PCMH is not a project, but a continual progression of the way care is delivered to patients, meeting them where they are. So, if you’re a practice that wishes to keep its PCMH, you’ll need to be accountable for each criterion you achieved when initially receiving PCMH recognition.