Whether they're offering recognition, certification or accreditation, some might argue that organizations evaluating whether medical practices meet the standards of a patient-centered medical home are all basically offering the same service. But there seems to be one clear differentiator emerging to help tell one program from another: on-site inspections.
Visiting medical homes
Currently, only the Accreditation Association for Ambulatory Health Care requires an on-site surveyor visit in its medical home certification program. According to spokesman Geoffrey Charlton-Perrin, this makes the AAAHC's offering "vastly superior."
The AAHC has certified more than 60 practices as medical homes. Charlton-Perrin says a mutually convenient time is arranged for certification visits, although for other AAAHC accreditation programs involving facilities requiring Medicare-deemed status, unannounced visits are done within a pre-arranged 90-day window.
For years, the Joint Commission was criticized because its hospital-surveyor visits were arranged well in advance and inspections had turned into well-choreographed events that did not reflect a facility's normal operations. That ended in 2006 when a policy of unannounced visits was launched. All hospitals know now is that the Joint Commission will show up some time before the third anniversary of its last survey.
The Joint Commission is field-testing its "primary-care home" accreditation program, which is set to launch in July. Michael Kulczycki, executive director of the Joint Commission's ambulatory-care accreditation program, says “our process is conducted on-site.” All initial surveys will be scheduled in advance, but plans call for reaccreditation surveys to be conducted three years later and they will be either unannounced or, under certain circumstances, done on "short notice."
The Patient Centered Health Care Home program at URAC, formerly the "Utilization Review Accreditation Commission," is currently "more of an educational offering," says Jane Webster, senior vice president of the group's research, development and planning.
The program offers a self-assessment tool kit, and Webster says URAC is moving in the direction of "evaluating the opportunity for providing certification or recognition" of practices as healthcare homes. She notes that there might be “some level of on-site audits,” but the percentage of visits to practices seeking certification hasn't been determined.
The National Committee for Quality Assurance has recognized some 1,800 practices as medical homes since 2008. NCQA spokesman Andy Reynolds says 5% of recognized medical are audited—and, while most are "desk audits," a few visits are made. Reynolds didn't have figures on how many on-site audits have been done, but says there are no plans to significantly increase them—or the accompanying plane trips, hotel stays and car rentals.
"We want to keep our program affordable—even for small practices," he says. "That's an expense we'd rather not pass to practices."
The organizations that drafted the original medical-home principals recently released a list of guidelines that they recommended evaluating organizations follow. The leader of one of those groups—the American Academy of Family Physicians—says requiring on-site inspections is not on the list—at least for now.
"It could be considered a gold standard," AAFP President Dr. Roland Goertz says of on-site inspections. But he added that the AAFP has not taken a position on whether it thinks so.
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