Three different organizations are vying in the growing area of accrediting patient-centered medical homes, which were given a boost by the healthcare reform law. And that competition is likely to heat up now that the CMS has proposed to pay primary-care physicians for non face-to-face care management based in part on medical home accreditation.
In its proposal to pay primary-care physicians for non face-to-face care-management activities, the CMS solicited public comment on whether third-party recognition as a patient-centered medical home could serve as proof that a practice was up to the task of providing these care-coordination services.
Medical home certification programs may have started as a marketing tool to help practices differentiate themselves from their competitors, but their importance has been elevated as some payers have boosted reimbursement to practices that have earned some level of third-party recognition.
Having recognized 5,770 practices as medical homes, the National Committee for Quality Assurance operates the largest of these programs. One way other organizations, such as the Joint Commission and the Accreditation Association for Ambulatory Health Care, have sought to differentiate themselves is to include onsite visits as part of their recognition process.
If third-party medical home recognition becomes part of a CMS payment process for care-management services, the stakes will be raised even higher.
The AAAHC, which has accredited 226 practices as medical homes and is based in Skokie, Ill., believes the value of onsite accreditation-survey visits will be raised as well.
“We believe the only reliable indicator for validation of patient-centered care is through the on-site visit process,” said Mona Sweeney, the AAAHC's assistant director of accreditation services. “AAAHC on-site survey and our accreditation and certification processes are not only thorough but are a reliable evaluation of an organization's ability to deliver care as a medical home.”
AAAHC also argues that lawmakers and regulators will find more value in onsite surveys.
“The purpose of the on-site survey is to have peer reviewers observe the culture, the dynamics and the quality of care in action,” she said. “Conducting patient, provider and staff interviews in addition to the in-depth review of written policies, clinical records, provider credentialing and privileging—all of these provide evidence of the best practices we expect from an accreditable organization.”
Sarah Thomas, vice president of public policy and communications for the Washington-based NCQA, said “a growing body of evidence” has shown that the NCQA's program can reduce cost while improving patient access and satisfaction.
“We encouraged CMS to accept NCQA recognition and are pleased that the proposed rule asks about this,” Thomas said. “Our program requires rigorous documentation on how practices meet our standards, and includes an audit process. We have considered site visits but it is not clear that they would lead to more accurate assessment.”
Amy Gibson, chief operating officer for the Patient-Centered Primary Care Collaborative, a coalition of 1,000 stakeholders advocating for medical homes, said her organization has not taken a position on this issue. “We don't advocate one as better than the other,” she said. “We certainly want practices to be rewarded for the things that they are doing.”