New NCQA program would mesh ambulatory clinics, medical homes

The National Committee for Quality Assurance has pitched a new patient-centered medical home program months after the group faced criticism for previous initiatives. The target for the new program: nontraditional ambulatory sites.

“We want to assess whether practice types like ambulatory care, urgent care centers, retail clinics, worksite clinics that aren't medical homes are really doing a good job of connecting patients back with primary care,” Patricia Barrett, NCQA's vice president of product development, said in a video.

NCQA's Patient-Centered Connected Care recognition program encompasses six broad standards (PDF) for ambulatory clinics: communication with patients' primary-care practitioners; referral processes; patient engagement; tracking lab and imaging tests; use of information technology such as electronic health records and electronic prescribing; and measurement of clinical outcomes.

The proposed clinical performance measures vary by type of facility (PDF). Retail clinics, for instance, would monitor five quality metrics, such as the percentage of children with upper respiratory infections who were not given a prescription for antibiotics. Worksite clinics, which are established on or near the grounds of an employer, would track 14 performance metrics—the most of any ambulatory site. Some of those measures include the quit rate of smokers and how much exercise patients get. Urgent-care clinics have nine proposed clinical measures.

Larry Boress, executive director of the National Association of Worksite Health Centers, said his trade group supports recognition and accreditation programs like the one NCQA is proposing, especially when it involves connecting a worksite clinic to a patient’s primary-care doctor. But choosing one program over another depends on the size and resources of a worksite clinic.

“(This) has got to fit with your business strategy, and we just don’t know what every employer will want,” Boress said. The NAWHC plans to read the standards further and potentially submit comments.

Officials with the Convenient Care Association and the Urgent Care Association of America were not immediately available to comment on NCQA’s proposed program.

The NCQA has been under the microscope this year after a study published in the Journal of the American Medical Association found NCQA-recognized medical homes—a model focused on coordinated primary care and shared data—did not perform much better in quality metrics than did groups without NCQA recognition.

The organization has since revised standards for medical homes, but critics say the NCQA still relies too much on processes and not enough on quality outcomes.

Public comment on the ambulatory medical-home standards runs through Aug. 6.

Follow Bob Herman on Twitter: @MHbherman



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