“Some of the real challenges we saw had to do with physicians letting go of some of the work that could be done by others,” she said.
The problem is that team-based care is a PCMH foundation concept; NCQA does not want physicians running around trying to do everything themselves, Ms. Miller said.
The 11 physicians in the practices simply weren't on board with the concept, “and it was clearly evident in the documentation they sent NCQA,” she said.
One approach is to divide out the tasks that need physician involvement from those that do not.
Nurses, for instance, could give pneumococcal shots to all patients older than 64 years under a standing order. The only thing the doctor would need to do is pull records periodically to make sure the shots are given, at least until they become automatic in the way that blood pressure checks are.
▸ You may have more documentation than you think. In working toward PCMH recognition, Ms. Miller also cautioned not to assume required documentation doesn't exist, especially in larger settings.
For example, one hospital-based residency practice was sure it couldn't meet NCQA's e-prescribing standard. After a little sleuthing, however, Ms. Miller discovered that the hospital pharmacy department had all kinds of e-prescribing practices and documentation in place, including alerts to prevent errors.
“The pharmacy department was able to take care of and coordinate that whole standard for the residency program,” Ms. Miller said.
“That was an eye-opener. Do not assume. You need to tell people [what you are doing],” she said.