Home Forums Discussions General Discussion medical home - help / advice to set up

i have been told that i need to set up a medical home.
Florida
i would appreciate any direction and help using amazing charts to succeed in being compliant with this.
thanks

Medical home means different things to different groups I am in the process of getting PCMH certified.

PCMH (Patient Centered Medical Home) can be an involved process and can be costly. It can mean greater reimbursement, and the process can help you "get your house in order" with things as diverse as job descriptions and setting procedures and policies.

What will it mean for you? That depends on how "together" your office is now and what your payor mix is and how much more they will pay for PCMH certification (and what level of PCMH they expect)

AC does many of the things you need for PCMH, a lot of it is based on meaningful use data, so it can be easy to get some of the data. A lot is not related directly to data.

You need to show, for example, that you sample data and make changes to improve outcomes. Fairly easy to do if you are experienced in using the report generator. But you then need to put in place a way to improve processes to get better outcomes and track them.

It is an involved process and can take a year to get certified. It will make some changes in how your office operates.

Is it worth it? Overall it helps to have external support to guide you. It will result in a more cohesive office and give both you, your staff and the patients a better understanding of the processes in your office. But it is a lot of work.

In Florida we sued for better payments to take care of medicaid patients. We won and AHCA had to increase the reimbursement. Now they decided that pediatricians can only receive the higher reimbursement if they are either board certified or are PCMH certified. That is their way of making sure that the majority of pediatricians will not get paid the higher reimbursement. We were notified a few months ago about this decision and since the higher reimbursement should start from October 1st visits the only offices that will get the higher reimbursement are those that are currently already PCMH certified. Since the cost for getting PCMH certification is high, only multiple physician practices and large multispecialty groups can afford it. Also the time period from the start to getting certified is very long(6-12 months), so even if we start now we would not get the increased reimbursement until next year. Somehow I feel that we have been duped and because of these obstacles it will be difficult to get higher reimbursement.
I do not notice anyone complaining or trying to do something about this deliberate attempt to not pay the higher reimbursement that was mandated after we had won the lawsuit.

Left this part out:

There are 2 main organizations that certify for PCMH. NCQA is the one most commonly used. Here are the steps to follow to become certified: http://www.ncqa.org/Programs/Recogn...Home-PCMH/During-Earn-it-PCMH.aspx#order
The cost depends on amount of providers in the practice and whether it is the first application or application for re-certification.
The practice earns points for each of 6 PCMH standards. Each standard has several elements and each element has several factors that have to be met. A certain percentage of the factors needs to be met to achieve the total points of that element. When surveyed for accreditation the points are earned and added up. The reason for the length of time needed is that some standards require data collection over a specific time period( months). This is why Wendell mentioned that it will take changes in how your practice operates. Your staff needs to be given job descriptions to accomplish roles which will make you meet the requirements to meet the standards. It does not only require rewriting you office manual with specific roles in the job descriptions, you have to show proof that the office is really performing according to the job description.
I was told by a surveyor that if you have a specific certified EMR you automatically are assured points, because the data gathering is built in. One EMR (I believe e-clinical? gives you 20 points from the start). A total of a 100 points can be acquired if all the standards are met.
I did not get an answer about AC. I believe that will require some extensive use and tweaking of the report generator. I believe that since PCMH is extremely important to us , AC needs to work on this.

and NO I have not started the process. I sat in with 2 meetings that a friend of mine set up for his practice and he paid the person thousands of dollars to help their practice to become PCMH certified.[u][/u]