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Sunday, February 25, 2018
HomeHealthNCQA Changes Medical Home Criteria

NCQA Changes Medical Home Criteria

From Nationaal Archiefs Photostream

From Nationaal Archiefs Photostream

In 2009, 11 nurse-managed health centers applied for “patient-centered medical home” designation from the National Commission on Quality Assurance (NCQA). At the time, only NCQA granted that designation and having it meant that a health center or primary care practice could receive additional payments for coordinating the care of patients, particularly those with multiple chronic illnesses.

NCQA’s criteria for the designation were developed with the American Academy of Family Physicians and the American College of Physicians (NCQA’s governing board is chaired by John Tooker, CEO of the ACP). Not surprisingly, the criteria required that a medical home be led by a physician. The 11 nursing-managed centers are led by nurses, although they include physicians as consultants or members of interdisciplinary teams. They were told by NCQA that they met all of the criteria–except that they were not physician directed. They were not given the designation.

In 2010, The Joint Commission announced that it is developing standards to accredit ambulatory health care organizations as “primary care health homes.” The change in language from “medical” to “health” homes conveys a shift in thinking about whether we’re focused on promoting health or simply treating diseases. I have been told that the standards developed by The Joint Commission will not include that a practice be lead by a physician.

So the handwriting may have been on the wall for NCQA as this new competition has emerged. They have reversed their position on the nurse-managed centers that had applied for medical home designation. NCQA has granted the designation to eight of these centers in Pennsylvania that are mostly safety net providers to underserved populations and have outstanding clinical outcomes. These centers are Project Salud of La Comunidad Hispana; Eleventh Street Family Health Services of Drexel University, Health Anned, and Abbottsford Falls Family Practice and Counseling of the Family Practice and Counseling Network; PHMC Health Connection, Rising Sun Health Center, and Mary Howared Health Center of Public Health Management Corporation; and the Children’s Health Center of VNA. All are members of the National Nursing Centers Consortium.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

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Diana is a co-director of the GW Nursing Center for Health Policy and Media Engagement and founder of HealthCetera. She was previously president of the American Academy of Nursing. She is senior policy professor at George Washington University and the Rudin Professor of Nursing at Hunter-Bellevue School of Nursing. She is a health policy expert and leader. Diana tweets @djmasonrn.

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