Still Have Recognition Redesign Questions? We’ve Got Answers.

So you watched the full Recognition Redesign Google Hangout and our host, Dr. Michael Barr, and our guests never quite got to your question. No worries. We answer some of the hundreds of questions submitted below. Check them out and follow for more answers in the future.

Is NCQA making changes to stay relevant or making changes that must be made? I believe the current PCMH program is having an impact. Why redesign something that is working?questions answers ask the right question and get an answer help

Your feedback drives these changes. They directly respond to the thoughts and suggestions made by practices. At the same time, NCQA considered literature review and our own principle of continuous improvement.

We know the redesign is ambitious. Still, we want to make the recognition process less cumbersome for you. The redesigned program will require less documentation and will focus on core requirements. Virtual reviews will allow practices to demonstrate their work as they progress and data submission will be automated, where possible. Practices will be able to use much of the reporting they do already.

What barriers or challenges (identified by providers, payors and so on) motivated Recognition Redesign?

We were told the current process:

  • Proves too difficult for small practices.
  • Focuses on process instead of performance.
  • Requires too much documentation.
  • Provides too little contact with a real person at NCQA.
  • Neglects opportunities for data acquisition.
  • Allows momentum to decline within the practice during the lengthy three year period before renewal.
  • Generates uncertainty that all practices are accomplishing what they claim.
  • Fails to inform practices of their submission’s status or need for revisions in a timely manner.
  • Provides too little education and guidance.
  • Requires the use of two separate, complicated tools.

How will the recognition program change, fundamentally? Will there be different measures, different documentation requirements, a different application process?

The application and recognition process will merge on a new software platform that allows practices, consultants and NCQA to communicate. Reviews will take place through virtual review “check-ins” that will continue throughout the recognition process.

NCQA anticipates that practices seeking recognition for the first time will progress through about three check-ins. After they earn recognition, practices will report annually to confirm that they continue to meet requirements.

How will the burden of documentation change?

A focus of our redesign is to both reduce required documentation and make it easier for practices to share documentation. We plan to introduce virtual reviews through desktop sharing for practices going through recognition for the first time. The online platform will be more intuitive and will let practices associate documents with more than one element or factor at once.

Will there be any addition or change to PCMH 2014 standards for the new annual recognition submission?

NCQA will base submissions through 2017 on PCMH 2014 standards. We expect annual reporting will allow NCQA to introduce new requirements when necessary to sustain recognition. NCQA will notify practices of any new reporting requirements during an anticipated six to 12 month notification window.

Will the standards/elements change significantly? Will changes be streamlined with MU updates, payer programs and PQRS?

The redesign concentrates on the process of becoming recognized, as opposed to focusing on the standards and elements. That said, NCQA is considering streamlining standards and elements in PCMH 2017.

The idea behind “must-pass” elements and Critical Factors has been to help practices focus on processes that must be implemented for PCMH recognition. Understanding that most clinicians do not leave any requirement as “optional,” we drafted the redesign to focus on a core set of requirements for earning recognition, providing a path for practices to receive credit for advanced capabilities.

When will the new standards go into effect? Will we continue using PCMH 2014?

Practices currently submitting surveys for recognition will use the PCMH 2014 standards until PCMH 2017 is released in March 2017. Public comment on proposed requirements will be announced this summer.

There will be an overlap in 2017 while practices become familiar with new requirements. We will retire the PCMH 2014 standards at the end of 2017.

If a practice is in the process of pursuing PCMH 2014 Standard Recognition, would you suggest holding off until the new redesign is released?

No! Practices that achieve recognition on PCMH 2014 standards have the choice of a three-year recognition and then moving to the annual reporting process in order to sustain it, or opting for an earlier transition to the new annual reporting process.

Will the standards chosen for documentation and reporting change every year? How far in advance will practices be notified about information they must submit?

We expect annual reporting will allow NCQA to introduce new requirements when deemed important to sustain recognition. Annual reporting updates should be available for sustaining practices within an anticipated six to 12 month notification window.

Will NCQA require yearly submission of Quality data and if yes, what mechanism will NCQA employ for 2017? How about a data feed rather than a document upload?

NCQA expects to introduce an optional path for practices to report electronic clinical quality measures directly or through a third party (e.g., EHR vendor, health information exchange, qualified clinical data registry) in 2017.

Are NCQA metrics aligned with CMS, AHIP and NQF Core Quality measures?

NCQA has identified a set of 35 measures that come from the CMS Meaningful Use program. A collaborative led by AHIP recently identified 22 PCMH/ACO measures. Thirteen of those measures are in the NCQA set. The nine that are not in the NCQA set have not been specified electronically, are for health plans, or are survey measures.

How does NCQA plan to support and promote the use of CCEs in practices?

NCQA’s new process and platform will encompass CCEs. CCEs will be able to monitor, review and assist practices throughout the transformation and recognition process.

Is there a knowledge base for sharing best practices among groups that have achieved or are seeking PCMH recognition?

Yes. Both our education programs and our community of CCEs are available to share their expertise on NCQA’s new education platform, Strategies for Success as a PCMH*.

NCQA hosts periodic Webinars, live seminars and CCE training. Start here for that. We can’t recommend PCMH Congress enough. It is a spectacular resource for learning about others experiences and advice for best practices.

*Go to Create an account (if you don’t have one already) and on the “MyApps” page, select the program.

What qualifiers will NCQA use to determine if the redesign is successful?

The redesign pilot programs were a good test of the new logistics and features, even though NCQA did not yet have the benefit of the new platform or a collection of clinical quality measures. After the redesigned process is released, we will collect data from early adopters to assess whether we are achieving our expected results.

Has the pricing schedule been determined?

We know pricing is always a concern for practices, so we take it seriously. Pricing is currently under development. Before it is finalized, we will conduct market research and talk directly to practices (large and small). We will balance those results along with the value this redesign generates. We can tell you our pilot practices’ results—as compared to the current process—demonstrate significant value in terms of reducing the time, people and resources they needed to achieve or sustain recognition.

For emerging primary care models, what has NCQA learned from PCMH that can inform future efforts?

From PCMH, we learned the need for ongoing quality improvement that focuses on all aspects of a highly functioning practice; the value of enhanced access; team-based care; population management; the importance of tracking and coordinating care; and well as patient-centered care management.

28 thoughts on “Still Have Recognition Redesign Questions? We’ve Got Answers.

  1. Our practice achieved PCMH 2011 Recognition on May 15, 2015. On May 15, 2018, Will we be required to have PCMH 2014 Recognition before going through an annual renewal? Or can we go through the annual renewal with our current PCMH 2011 Recognition?

    1. Hi Nancy, Based on what you provided here, our Rec Redesign team says it looks like you’d submit to renew to PCMH 2014 by March 31, 2017, which will give you a new 3 year recognition period and will not fall into annual reporting until 2020. NCQA is not accepting any renewals after March 31, 2017. We do have options though. Your other option is to convert to PCMH 2014. Converting will extend your recognition for 12 months and then you will fall into annual reporting after that.

      1. Based on that answer, a practicing achieving 2014 PCMH recognition this year (November 2016) will not fall into annual reporting until 2019. Does it matter at what level the practice is recognized? Will the transition be easier from a higher level of recognition?
        Thank you.

        1. Practices recognized as PCMH 2014 Level 3 will transition directly into the sustaining phase (annual reporting to sustain recognition) at the time of their recognition end date (e.g., for practices recognized in November 2016, annual reporting would begin in November 2019). There will be a process for Level 1 and 2 practices to enroll in an accelerated PCMH 2017 engagement program which will enable them to move into the sustaining phase.

  2. Hello, we currently have our PCMH recognition through BCBSM’s PGIP program since 2011 and I would like our practice of obtain NCQA Recognition. Any suggestions of where to start? Thank you.
    Tiffini Jones
    Allenwood Family Health Care

    1. Great to hear your news. We look forward to working with you.Let us know if, for some reason, our recognition experts were not able to reach you. They’ll get you on the NCQA path as soon as they can. Thanks again!

  3. Our multi-site PCMH Level 3 recognition is set to expire at the end of March 2017 and we are already working on getting prepared for re-accreditation. Is there any way to pilot the 2017 standards which seem to be more in line with our model of care delivery?

    1. Hi Kari,

      Good question. We’ll pass your information along to the recognition team and someone will contact you. It is worth noting, we may not quite be there just yet… As you know, the recognition redesign is more about making the process more user friendly for those seeking or maintaining recognition. Development of the standards is a separate process. Still, look for a call or email.

  4. Per your statement above from 3/7/2016: “NCQA is not accepting any renewals after March 31, 2017.” For a multi-practice site (first site has a recognition period of 1.17.2015-1.17.2018) that wants to renew, what exactly has to be done by 3.31.2017? Application? Survey tools purchased? Corporate attestation completed? Site attestations completed?

    1. Multi-site organizations who want to renew under PCMH 2014 must submit the corporate survey tool and purchase single site survey tools by March 31, 2017. All single site survey tools must be submitted by 9/30/2017.

  5. Clarification on March 30, 2016 comment: PCMH 2011 recognition achieved (1.17.2015-1.17.2018), looking to renew using 2014 standards. What exactly must be completed by 3.31.2017? Application? Survey tools purchased? Corporate attestation completed? Site attestations completed? Thanks.

    1. Practices who want to renew under PCMH 2014 must purchase survey tools by March 31, 2017. All single site survey tools must be submitted by 9/30/2017. If a multi-site organization wants to renew, it must submit its corporate survey tool by March 31, 2017.

      1. I have a question in regards to Kathy’s query from 4/1/16 and the associated reply. . We have PCMH 2011 recognition achieved (1.17.2015-1.17.2018) for our first site with later recognition dates for the subsequent sites.
        Is it an option to wait until the end of our current attestation period and apply for PCMH 2017 instead?
        If applying for PCMH 2017 (skipping renewing to 2014) is an option, do all sites apply at the same time and have certification for only 1 year? Thank you.

        1. Practices do have the ability to wait and participate in the full engagement process for 2017 if they do not wish to renew or convert to PCMH 2014. The requirements for PCMH 2017 are scheduled to be released in March 2017.

          If a multi-site chose to do conversions, each site submits separately and must submit by the 9/30/17 deadline – in this case, the sites would all achieve a 12 month extension from their recognition end date, so the sites would still all have different recognition end dates. Renewal would also require the corporate submission by 3/31/17 and all sites by 9/30/17, but under our multi-site policy, they would all achieve the same end date based on the recognition period of the first site recognized (e.g., if the first site is recognized on 6/30/2017, all other sites would have the same recognition end date of 6/30/2020).

          If folks have very specific questions like this, consider consulting our monthly live Q&A sessions on renewal and conversion on our training calendar: These venues might be more helpful for folks who are looking for more tailored guidance.

  6. Hi Matt,

    Once a group achieves PCMH recognition through NCQA are there any benefits regarding the renewal process if a practice achieves level III instead of just level II? Perhaps less required documentation, less cost, quicker process, etc.?

    Thank you Matt,

    1. Hi Jesse,

      If a practice pursues the renewal process, there is no difference for level 2 vs. level 3 practices – both are eligible for streamlined renewal. Level 1 practices are not eligible for streamlined renewal and are required to submit a full survey for renewal. PCMH 2011 Level 3 practices are eligible to either convert or renew, while conversion is not an option for PCMH 2011 Level 2 practices.

      Hope that helps. We aim to make these transitions to the new process as simple as possible. The redesign is specifically aimed at tackling the concerns you mention by reducing paperwork, adding more personal service from our team, saving you on administrative costs for gathering all the documentation and streamlining reporting so you have more time to concentrate on patients.

  7. Matt, my question relates to your April 7th response to Alison, “Practices do have the ability to wait and participate in the full engagement process for 2017 if they do not wish to renew or convert to PCMH 2014. The requirements for PCMH 2017 are scheduled to be released in March 2017.” We attained Level 3 for 4 practice locations in February 2015 (corporate + individual sites). If we decide to apply for PCMH 2017, what is the deadline for submission? Is corporate application required, plus all four sites. If so what is the deadline? Thank you, Lisa

  8. There seems to be a disparity in when the Corporate Survey Tools need to be submitted by under the 2014 Standards – above here you state March 31st 2017 and other information on the NCQA website says May 31st 2017 – can you please clarify which date is accurate. thanks you.

    1. Julie, the correct date is May 31st. We extended it, but apparently missed some spots where it needed correcting. We’re on it! Thanks!

  9. We just submitted our Corporate Survey tool so I expect to have the results in late Nov or December. Then we have 19 practices to complete individual surveys. Will we have the full 12 months to be able to do that based on the timing. If we are unable to get all 19 individual survey tools for the PCMH 2014 program in by the cut off, what then?

  10. My multi-site organization is considering applying for the first time for PCMH Recognition. My understanding is that we need to summit the application and the Corporate Survey Tool by 31 Mar 2017 and purchase the site survey tools by this date as well. Site survey tools must be submitted by 30 Sep 2017. We will begin the gap analysis by the end of this month. The standards state that certain items must be in place for three months to qualify. Does this mean that the elements must be in place by 1 Jan 2017 (31 Mar 2017 – 90 days) to meet the Corporate deadline or by 1 Jul 2017 (30 Sep 2017 – 90 days) to meet the site deadline?

  11. Under the new 2017 Standards and Guidelines, our organization wants to recert as a multi-site organization, but we have 2 sites that are not certified and 2 sites needing to recertify. Is it possible to mix recert sites and first time certification sites to accomplish a multi-site organization certification?

    1. Hi Ashley~
      If the currently recognized sites are PCMH 2014 Level 3 they will go into succeeding. For non-recognized sites they will need to go through transform for 2017. They will be able to share criteria even though it is just two sites as Q-PASS can accommodate this now.
      Let me know if you need further clarification, thanks!

  12. I am trying to compare 2014 to 2017, can you please explain TC3 and TC4? Are these similar to any in 2014?

  13. I have a question about QPASS and multisite practices. If a site does not meet the requirements for a corporate submission (same EHR and policies & procedures) will the individual site be required to set up a separate QPASS access or will the site be set up under the corporation’s QPASS access yet still required to submit on its own?

    1. Hi Kathi~
      From Brett Kay, AVP Recognition Operations, Product Delivery:
      Sites that do not meet the “multi-site” requirements should still all register under one “corporate” account. They can set up different site groups or enroll each site separately in the PCMH program (still under the single organization). They can still share some criteria across all of the sites, so long as those functions really are the same across the sites.

      If you have any further questions please feel free to comment here and we’ll get back to you. Thanks for reading and commenting!

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