The Patient Centered Medical
By Marnie Manske, BSRT, MHA
• Patient Centered Medical Home (PCMH)
is a means of enhanced reimbursement
by both federal and private insurers;
certification is the beginning step for
preparation of new healthcare reform
standards yet to come.
• PCMH certification standards are rele-
vant to radiology departments and not
just limited to primary care.
• Work done for PCMH efforts can be
utilized as overall process improvements
that the department of radiology can
submit for other organizational initia-
tives as well as accreditations. As critical
as radiology is in the application process,
it currently has a very small portion of
the overall project.
The Patient Centered Medical
Home (PCMH) is a model of healthcare
based on an ongoing, personal relationship between a patient, doctor, and the
patient’s care team. When specialty care is
needed, at the patient’s request, the doctor and care team will personally manage,
facilitate, and coordinate the care with
appropriate qualified professionals, such
as hospitals, nursing homes, pharmacies, and related community resources.
The PCMH model proposes to improve
primary care by focusing on the patient-doctor relationship and to strengthen this
dynamic through a more comprehensive approach to patient care and more
active patient involvement. 1 The PCMH
encompasses care for all stages of life
including acute and chronic care, preventive services, and end-of-life care. 2
Four organizations offer PCMH
status—the Accreditation Association for
Ambulatory Health Care, the National
Committee for Quality Assurance
(NCQA), URAC (a healthcare accreditation agency), as well as The Joint
Commission. 3 Following is a generalization of the NCQA process.
Pursuing NCQA PCMH Certification
Usually the first step an organization goes
through when pursuing certification
is a cost benefit analysis on whether to
pursue it, which is usually started by the
organization’s primary care leadership.
Some are assuming that this will become
one of the mandates of healthcare reform
moving forward so staying ahead of the
curve may be strategically significant.
Once it’s determined to move forward,
the organization must formally apply.
This usually involves an application fee
and simple information form to be filled
out. Standards are then sent to the orga-
nization detailing everything required
to attain different accreditation levels
and are reviewed by the organization’s
leadership to determine the highest
level achievable. Even though the high-
est level is usually what most would like
to pursue, some simply do not have the
information technology or operational
systems in place to do so.
1. Enhance Access and Continuity
2. Identify and Manage Patient Populations
3. Plan and Manage Care
4. Provide Self-Care Support and Community Resources
5. Track and Coordinate Care
6. Measure and Improve Performance