The Patient Centered Medical Home Model
identifying specific measures and working with continuous quality improvement techniques to improve patient care.
Accountability of reporting metrics and
data externally is not only part of the
medical home but many other quality
NCQA PCMH Aspects Specific to Radiology
The “Track and Coordinate Care” section
of the NCQA PCMH application has
specific components involving radiology.
These include the following:
• Tracking radiology results—flagging
and following up with results is a
component of the application.
Depending on the patient outcome
results that the primary care area decides
to report and submit for the application,
radiology may have a factor in this section as well.
When one looks at the whole PCMH
application process it’s very evident that
as radiology is a critical component, it
is a small portion of the overall workload towards submission. If a colleague
from primary care, quality, or any other
department approaches radiology needing assistance in these sections of the
application, the radiology department
staff may have a better understanding.
The application process may even require
the radiology department to develop a
policy that it may not already have or
update an existing one. Radiology may
have to create or change a process that
will involve not only the technologists,
but radiologists as well. Even this small
section of a much larger initiative can
become a lot of work for a lot of people
in the radiology department.
The end result of all this potential
work will be enhanced reimbursement
for the organization—the radiology
department can be a team player and
play a critical role in achieving this. Other
results could include better patient out-
comes and processes as well as updated
policies that are more relevant to the
current environment. Process improve-
ments could be attained that could
subsequently be reported since most
organizations track those.
The PCMH model is a significant part of
the overall healthcare reform initiative.
It is recognized by the government as a
standard justifying enhanced financial
reimbursement to those organizations
that achieve recognition. Radiology is
an essential part of a patient’s healthcare
and has a small but significant role in
the PCMH application process. Ensuring radiology test results are available in
a timely manner to the primary care provider, patient, and their families is radiology’s contribution to patient centered
care within the medical home model.
The PCMH model is one example
of how healthcare is becoming more
about the needs of the patient and less
about bureaucracy and red tape. Hospital
departments and physician practices
have traditionally worked independently
of each other rather than as a team. The
silos that once dictated operational processes regardless of what it did to patient
care have become obsolete and are
viewed as nothing more than negative
obstructions to getting the work done.
Organizations with new leadership and,
in some cases, outside consultants are
very quick to identify the silo dynamic.
The result is usually an introduction of
a new organizational culture or other
The large and tedious workload
involved in a PCMH application is such
that organizations must modify and
change the mindset of how they do things.
Simply putting a Band-Aid on an existing
workflow that has broken or dumping a
new one to accommodate a new regula-
tion will not work anymore. Years and
years of patches and shortcuts have come
to a head and a restructuring, essentially
from scratch, is necessary with new atti-
tudes and mindsets of teamwork and
patient centered care. Healthcare reform
is like a train racing forward—either get
on board or fall off at the turn.
1Blue Cross and Blue Shield Association.
Patient Centered Medical Home (PCMH).
Available at: http://www.bcbs.com/
home/. Accessed February 3, 2013.
2BCBSA Demonstration Project Press Release.
Available at: http://www.pressreleasepoint.
release. Accessed April 30, 2013.
3MGMA-ACMPE. Patient-Centered Medical
Home. Available at: http://www.mgma.
com/PCMH/. Accessed February 3, 2013.
4Department of Health & Human Services
(DHHS), Centers for Medicare & Medicaid
Services (CMS). CMS Manual System.
October 25, 2011. Available at: http://www.
R81DEMO.pdf. Accessed February 3, 2013.
5HIMSS/NCQA. Leveraging Health IT to
Achieve Ambulatory Quality: The Patient-
Centered Medical Home (PCMH).
National Committee for Quality Assurance
website. Available at: http://www.ncqa.org/
February 3, 2013.
Marnie Manske, MHA, BSRT is assistant director of
PCMH operations with the New York City Health &
Hospitals Corporation and is a part time adjunct
faculty instructor with the Metropolitan College of
New York’s program in healthcare management.
She has over 15 years of clinical and managerial
experience in medical imaging with experience in
healthcare quality, operations, and revenue cycle
management in academic medical settings, hospitals,
and physician group practices. Marnie is in her second
year as a board member with the New York City chapter
of the Medical Group Management Association and
can be reached at email@example.com.