The Joint Commission is taking aim at the growing patient-centered medical home movement.
No place like home?
Primary-care home option gets praise, questions
The Oakbrook Terrace, Ill.-based not-for-profit quality group recently announced plans to expand its ambulatory-care accreditation program to offer providers an optional primary-care home designation. And hospitals may be offered the same option in the future.
Some physicians, however, said the addition of another accrediting body could add confusion and conflicting requirements—a burden they say is particularly unwelcome at a time when the standards for medical homes are still in their early stages of development.
“It will be chaotic,” said Greg Sharp, who runs a two-physician family practice office with his wife in Woodland Park, Colo. Sharp's office, Ideal Family Healthcare, is one of 16 practices currently participating in a multi-payer patient-centered medical home pilot in Colorado. “Doctors are going to be wondering who they need to report to and if there is no synchronization, it could become very difficult,” Sharp said.
But according to Lon Berkeley, Joint Commission's project director for community health center accreditation, it was feedback from ambulatory-care providers—many of which are engaged in similar patient-centered medical home demonstration projects—that convinced the Joint Commission to expand its accreditation offerings.
Berkeley declined to discuss any of the specific standards for the new program, known as the Primary Care Home Initiative. But he did say the voluntary accreditation process would cover expected topics such as patient self-management education, clinical decision support and electronic prescribing. The organization plans to post the standards for field review in November and then begin pilot testing early next year. The program is expected to officially launch in July 2011, the Joint Commission said in a news release.
In addition, Berkeley said, the Joint Commission anticipates offering the same program to hospitals and behavioral health organizations sometime down the road.
One problem with new standards for accreditation, physicians say, is that many practices are already accustomed to the patient-centered medical home standards set by the National Committee for Quality Assurance, a Washington-based, not-for-profit healthcare quality improvement organization. “I'm in favor of one-stop shopping,” said Michael Mignoli, who runs his own internal medicine practice in Lone Tree, Colo. “I've been pleased with NCQA so far, and my worry is that some payers might decide they want to recognize certification from one organization but not the other. It's tough enough as it is to keep up with what we need to do to function as a medical home.”
NCQA also seemed less than pleased by the news. Patricia Barrett, NCQA's vice president of product development, said multiple approaches to recognition and certification could leave stakeholders frustrated. “Having different standards and models can mean that patient-centered medical homes will mean different competencies and expectations across the country,” Barrett said in an e-mail.
But Bruce Bagley, medical director for quality improvement for the American Academy of Family Physicians, argued that there is plenty of room at the table for multiple accreditation bodies as long as there is some consensus about what accreditation should entail.
And although NCQA hit the ground running early on, he said, several other organizations are currently certifying medical homes (June 14, p. 10). For instance, URAC, a Washington-based quality organization, said it plans to launch its completed patient-centered medical home program in 2011.
The Accreditation Association for Ambulatory Health Care is also offering medical home accreditation.
Chester Cedars, a family medicine physician whose office, Lone Tree Family Practice, is also based in Lone Tree, Colo., cautiously welcomed the idea of additional accreditation organizations, saying it could do more to convince payers of the viability of medical homes.
“I believe in competition,” Bagley agreed. “Each one of these organizations is set up differently and has a niche that they are trying to expand on. What is important is that they all convey that the practices that receive accreditation are doing these specific things. That's the common currency.”
The AAFP is currently working with several other organizations to develop joint principles for medical-home accreditation programs, Bagley added.
Bagley did acknowledge that the Joint Commission's reputation as clipboard-wielding overseers might be hard for physicians to accept—a view Sharp, from Ideal Family Healthcare, shared.
“I don't want the process of becoming a medical home to be any more painful or scary than it already is,” Sharp said.
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