Ambulatory Care Accreditation: 2007 Joint Commission Standards and Survey Process for BPHC For Supported Programs

The Joint CommissionsPrimary Care Home Initiative

National Hispanic Medical Association 15th Annual Conference Washington DC March 17, 2011

Angelica Flores MDAmbulatory Care Clinician SurveyorThe Joint Commission

Copyright, The Joint Commission # Copyright, The Joint Commission1Topics to be CoveredOverview of The Joint CommissionPrimary Care Home Initiative Background and PlanningConnecting Accreditation with the Primary Care Home OptionProposed Primary Care Home Requirements Contacts

# Copyright, The Joint Commission2What is The Joint Commission?A private, not-for-profit organization created by and governed by health care professionalsOur Board of Commissioners comprises individuals who understand the complexity of health care and the challenges our customers face everyday in the delivery of health careAdministrators, doctors, nurses, ethicists, members of the publicOur five corporate members represent the leading health care associations in the United States: American Hospital AssociationAmerican Medical AssociationAmerican College of PhysiciansAmerican College of SurgeonsAmerican Dental Association # Copyright, The Joint Commission3Vision: All people always experience the safest, highest quality, best-value health care across all settings.

Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

Emphasizes twin aims:Thorough evaluation against Joint Commission standards Effective motivation of organizations to use the results of that evaluation to drive improvement.The Joint Commissions Vision & Mission Statements # Copyright, The Joint Commission4To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

Commitment to Improving Safety and Quality of CareWith more than 50 years of health care accreditation experience, the Joint Commission works with customers to address the most serious patient safety and quality issues in health care We work with national experts and seek input from the field to:Ensure state-of-the-art standards and accreditation process Promote optimal safety and quality for patients Panels allow opportunity to directly provide input and feedback:Advisory Councils: Business; Patient & Family; Nursing; Patient Safety Professional and Technical Advisory Committees # Copyright, The Joint Commission5The Joint Commission ModelGeneral customer baseAccredits or certifies over 19,000 total organizations (hospitals/CAH, labs, behavioral health, home care/DME, long term care, ambulatory care/OBS)Accrediting Ambulatory Care since 1975:Wide variety of ambulatory settingsMedical/dental settings, including:Federally Qualified Health CentersMedical Group PracticesAmbulatory Care program now accredits over 1,900 organizations with 6,400 sites of care

# Copyright, The Joint Commission6The Joint Commission Model (cont)Accreditation partnership = Independent, outside evaluationComponents = continuous compliance with ambulatory care standards:On-site survey, every 3 yearsAnnual self-assessment during interimFocus on processes for ensuring patient (and staff) safety # Copyright, The Joint Commission7Features of Joint Commission Accreditation Accredited Ambulatory Care OrganizationPeriodic Performance Review (PPR)On-site EvaluationUnannounced Surveys with Tracer MethodologyExperiencedHealth CareProfessionals asSurveyorsStandardsInterpretationGroup EducationCustomer AccountExecutiveOperational Toolsfor Good ManagementLessons Learnedfrom other OrganizationsElectronicManualRisk Reduction ProcessNPSGsState-of-the ArtStandards # Copyright, The Joint Commission8New Value-adds for Customers (see end slides)Center for Transforming Healthcarewww.centerfortransforminghealthcare.org Targeted Solutions Tool

Leading Practices Library

WikiHealthCareTM Interactive Forum

# Copyright, The Joint Commission9Recent Developments at The Joint Commission2007: Name/Logo Change2008: Patient-Focused Efforts: Speak-upTM2009: New Vision/Refreshed Mission 2009: Launch of Center for Transforming Healthcare2010: Launch of Targeted Solutions Tool 2010: Primary Care Home Initiative # Copyright, The Joint Commission10

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# Copyright, The Joint Commission12Primary Care Home Initiative BackgroundJoint Commission response to new model of primary care delivery being pilot tested nationally = patient-centered medical homeDemonstrations/pilots include added reimbursement for providing better access to care, new care coordination, monitoring patient outcomes, & more patient education Accredited ambulatory care orgs also want The Joint Commission to qualify them to participate in demosPart of proposed health care reform quality (Section 3024) & cost-reduction options # Copyright, The Joint Commission13TERMINOLOGYGenerally Equivalent Labels: Patient-Centered Medical Home Health Care Home Advanced Primary Care Practice Primary Medical Care Home Primary Care Home # Copyright, The Joint Commission14Primary Care Home InitiativePhase I Workplan 2010: Development of PCH model, draft standards/EPs (Expert Panel/PTAC) Model & requirements based on generally accepted core PCH conceptsEarly 2011: Field review, survey process pilot testing, and further input from stakeholders, private/public payers, revisions Late Spring 2011: Release of new requirements via websiteJuly, 2011: Implementation for Ambulatory Care accredited customers # Copyright, The Joint Commission15Multiple Sources for Core Concepts

Patient-Centered Primary Care CollaborativeJoint Principles of the PCMH (AAFP,AAP,ACP,AOA)Agency for Healthcare Research & Quality (AHRQ)Veterans Health AdministrationCommonwealth Fund/Qualis HealthCMS Meaningful Use DefinitionsBlue Cross Blue Shield of MichiganMinnesota Depts of Health/Human ServicesInstitute of MedicineCenter for Medical Home ImprovementNational Partnership for Women & Families # Copyright, The Joint Commission16Using AHRQ Definition of Medical Home

# Copyright, The Joint Commission17Using AHRQ Definition of Medical Home

# Copyright, The Joint Commission18Primary Care Home Model Operating Characteristics Include: Interdisciplinary care team Personal primary care clinician Comprehensive and continuous carePatient-centered careCoordination of careFocus on safety and quality Enhanced access to careAccess to specialty care and other resources needed to provide care

# Copyright, The Joint Commission19Joint Commission Ambulatory Care Accreditation Plus Primary Care Home OptionAmbulatory Care Accreditation(~ 900 applicable standards pertaining to medical settings, including 123* applicable to PCH)Primary Care Home Option (54 additional requirements*)Increasing Patient-Centeredness, Comprehensiveness,Access, Coordination* Based on field review draft

# Copyright, The Joint Commission2020Ambulatory Care AccreditationPrimary CareHome OptionCurrent EPs (~900)New EPs (54*)Current EPs(123*)Total EPs(Elements of Performance) Required for Primary Care Home Option (177*)Joint Commission Primary Care Home Option Overlap with Ambulatory Care Accreditation* Based on field review draft # Copyright, The Joint Commission21

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Copyright, The Joint Commission # Copyright, The Joint Commission23Features of Primary Care Home Option At this time, will only apply to an accredited ambulatory care organization Onsite survey process to confirm compliance with additional requirements No special application requirementsOrganization-wide designation for up to three yearsPrimary Care Home designation publicly available on Quality Check Included as part of HRSA/BPHC contract

# Copyright, The Joint CommissionMention that24Primary Care Home Operational Characteristic: Comprehensive Care 1 current EP required for Accreditation 13 additional EPs proposed for PCH optionThe organization provides acute, preventive, and chronic care The organization provides care that addresses various phases of patient lifespan, including end-of-life care The organization provides disease/chronic care management servicesThe organization identifies members of interdisciplinary team (team)MD/DO actively participate on interdisciplinary team Primary Care Clinician (PCC) works collaboratively with interdisciplinary team # Copyright, The Joint Commission25Primary Care Home Operational Characteristic: Comprehensive Care (cont) 13 additional EPs proposed for PCH optionPCC/team provide or arrange for comprehensive/continuous carePCC works with team to provide/coordinate careTeam members participate in developing treatment planPCC/team assess health risk behaviorsPCC is ultimately accountable for patient carePCC has background/experience/knowledge to handle most patient medical needs & resolve conflicting care recommendationsOrganization manages care transitions & provides/facilitates access to: acute care, chronic care, age/gender-specific preventive care; behavioral health needs; dental care (Note: OK to use/collaborate with community resources)

# Copyright, The Joint Commission26Primary Care Home Operational Characteristic: Superb Access to Care 0 Current EPs required for Accreditation 3 Additional EPs proposed for PCH option24/7 access to: appointment scheduling; prescription renewal; test results; billing/registration; clinical advice re urgent health needs; health education infoOffer flexible scheduling (e.g. open access, expanded hours, same day appointments)Have process to address urgent care needs 24/7 # Copyright, The Joint Commission27Primary Care Home Operational Characteristic: Coordinated Care 19 current EPs required for Accreditation 10 additional EPs proposed for PCH optionPCC/team provide care to panel of patientsPCC/team use health promotion strategies that focus on prevention/management of chronic illnessPatient self-management goals identified/incorporated into treatment plan and progress toward achievement monitoredUse HIT to: track/coordinate care; support disease management and preventive care; internal/external reporting; electronic exchange of information among internal/external providersPCC/team review/track care to referred organizations and act on recommendationsClinical record contains info from both internal & external providersOrganization provides population-based carePCC/team function within scope of practice and privileges

# Copyright, The Joint Commission28Primary Care Home Operational Characteristic: Patient-Centered Care 54 current EPs required for Accreditation 22 additional EPs proposed for PCH OptionEach patient selects primary care clinician Involve patients in Performance Improvement Involve patient in developing own treatment plan & partner with patient to achieve planned outcomes PCC/team identify patients oral/written communication needs, including preferred language, and communicates in manner that meets those needsPCC/team identify health literacy level and incorporate into patient educationPCC/team educate patient on self-management toolsClinical record contains: patient communication needs; race/ethnicity; self-management goals & progressOrganization provides interpretation and translation services

# Copyright, The Joint Commission29Primary Care Home Operational Characteristic: Patient-Centered Care (cont) 22 additional EPs proposed for PCH OptionThe organization respects the patients right to: Make decisions about management of care Obtain care from other clinicians within the PCHSeek a second opinion and specialty careThe organization provides information to the patient about:Mission, vision, goals of PCH & scope of care/types of servicesHow to access PCH for care or informationPatient responsibilities re health history, current medications, and self-management activitiesRight to obtain care from other clinicians within PCH, seek a second opinion, and specialty care.How PCH functions regarding: process to select PCC, involve patient in treatment plan, obtain/track referrals, coordinate care, and collaborate with patient-selected clinicians providing specialty or second opinions. # Copyright, The Joint Commission30Primary Care Home Operational Characteristic: Systems-based Approach to Quality & Safety 29 Current Elements of Performance required for Accreditation 6 Additional EPs proposed for PCH optionUse HIT to support Performance ImprovementUse E-prescribing processUse clinical decision support tools Collect/use data on disease management outcomes & access to care within timeframesPrimary Care clinician/team participate in Performance Improvement

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# Copyright, The Joint Commission32FOR MORE INFORMATIONMichael Kulczycki, Executive Director Ambulatory Health Care Accreditation:630-792-5290mkulczycki@jointcommission.orgLon Berkeley, Project Lead, PCH InitiativeProject Director, Community Health Center Accreditation 630-792-5787lberkeley@jointcommission.org

# Copyright, The Joint Commission33Questions?

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# Copyright, The Joint Commission35Future Center solutions availableWrong site surgery: June 2011

Hand-off communications: late 2011

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# Copyright, The Joint Commission37Leading Practices LibraryLaunched 2010 as complimentary, web-based service Offers customer-generated library:Sample policiesPatient satisfaction surveySafety risk assessmentSorted by applicable program (eg AHC) or by standards chaptersShare your own leading practices with others

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# Copyright, The Joint Commission39Library is web-based resource

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