It should allow for separate fee-for-service payments for face-to-face visits. (Payments
for care management services that fall outside of the face-to-face visit, as described
above, should not result in a reduction in the payments for face-to-face visits).
It should recognize case mix differences in the patient population being treated within
the practice.
It should allow physicians to share in savings from reduced hospitalizations associated
with physician-guided care management in the office setting.
It should allow for additional payments for achieving measurable and continuous quality
improvements.
C.
The PPC-PCMH Standards -
http://www.ncqa.org/tabid/631/default.aspx3
Standard 1: Access and Communication
A. Access and communication processes**
B. Access and communication results**
Standard 2: Patient Tracking and Registry Functions
A. Basic system for managing patient data
B. Electronic system for clinical data
C. Use of electronic clinical data
D. Organizing clinical data**
E. Identifying important conditions**
F. Use of system for population management
Standard 3: Care Management
a. Guidelines for important conditions
b. Preventive service clinician reminders
c. Practice organization
d. Care management for important conditions
e. Continuity of care
Standard 4: Patient Self Management Support
A. Documenting communication needs
B. Self-management support**
Standard 5: Electronic Prescribing
A. Electronic prescription writing
B. Prescribing decision support - safety
C. Prescribing decision support - efficiency
Standard 6: Test Tracking
3 : Must-Pass Elements
