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Joint Commission to accredit medical home models

Some physicians welcome the group's entry, while others say they will still rely on NCQA recognition standards.

By — Posted Oct. 18, 2010

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As Medicare explores how medical homes can help physicians provide the best care for patients, the Joint Commission in September announced that it will begin accrediting patient-centered medical home models for physicians by July 2011.

The Joint Commission, based in Oakbrook Terrace, Ill., said the new initiative complements its ambulatory care accreditation program and is consistent with the efforts of the new health system reform law that call for improvements in the coordination, quality and delivery of services.

A medical home model is a method of delivering care that differs from traditional fee for service in that payments are based on an ability to demonstrate evidence-based protocols, self-management education, and care coordination with specialists and other facilities.

The final standards from the Joint Commission are expected to be available in March 2011, and the group plans to begin performing on-site surveys by July 2011.

"This new optional program will help ensure that patients receive ambulatory care services in a manner that is comprehensive, accessible and coordinated," said Michael Kulczycki, executive director of the Joint Commission's ambulatory accreditation program. "By focusing on carefully orchestrating care, patient outcomes can be improved."

The American Medical Association has strong policy related to patient-centered medical homes and will watch how the commission's standards develop. "We are very interested in, and will continue to track closely, the work of the Joint Commission to ensure that any proposed accreditation standards include a focus on patient safety and access to physician care," said AMA President Cecil B. Wilson, MD.

Some practices are used to following recognition standards that were set in 2008 by the National Committee for Quality Assurance, a Washington, D.C.-based nonprofit health care quality organization.

"Some questions need to be answered before we start pushing ahead with more accreditors," said Greg Sharp, MD, who owns Ideal Family Healthcare, a two-physician family practice based in Woodland Park, Colo. The concept of medical homes as a payment delivery system is still in its early stages, he noted.

The Centers for Medicare & Medicaid Services has three medical home demonstrations under development, and several other nongovernment projects have been completed.

Ideal Family Healthcare received a level 3 recognition status from NCQA in June 2009, which is the highest level the organization offers.

"I have some experience with the medical home model, and there's a lot of excitement about it," Dr. Sharp said. "But we need to give this some time to see what kind of effect this model has on health care delivery."

"Healthy competition"

One medical home project outside CMS' purview involved 35 small and midsized practices sponsored by TransforMED, a wholly owned, for-profit subsidiary of the American Academy of Family Physicians.

Bruce Bagley, MD, AAFP's medical director for quality improvement, believes the medical home model has matured enough that the health care industry is ready to welcome a new accreditor. "There's always room for healthy competition, and these accreditation plans are going to have a different niche and will help doctors in a different fashion," he said.

Dr. Bagley said solo or small physician practices may prefer the NCQA standards. The Joint Commission standards will involve an on-site visit and may be more expensive, he said.

Allan Crimm, MD, agreed that the addition of the Joint Commission to the medical home accreditation field is beneficial for the industry.

Dr. Crimm is an internist and managing partner of Ninth Street Internal Medicine, a nine-person practice in Philadelphia. His practice has been involved in the Southeast Pennsylvania Collaborative, a three-year medical home program begun in May 2008.

"I really don't care who does the housekeeping stamp of approval," said Dr. Crimm, whose practice has received level 3 status from NCQA.

"Right now, it's a fragmented and poorly organized system. So whatever avenues that provide recognition for practices that have taken these steps to transform themselves and switch to another system would be welcomed," he said.

NCQA leaders believe more accreditation or recognition bodies would only muddy the landscape.

"We are concerned that the proliferation of patient-centered medical home recognition approaches will cause confusion and frustration among physicians and providers," said Patricia Barrett, NCQA's vice president of product development.

She warned that payers might become frustrated with too many parties attempting to accredit or recognize medical homes.

"It could impact payments if different payers adopt different standards as the basis for those payments -- which would then require the practices to go through multiple review processes," Barrett said.

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