AAFP, AAP, ACP and AOA release new guidelines for effective PCMH recognition programs

Four organizations representing more than 350,000 primary care physicians today released joint "Guidelines for Patient-Centered Medical Home Recognition and Accreditation Programs." The new guidelines - created by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association - build on the Joint Principles of the Patient-Centered Medical Home, which the four groups developed and adopted in February 2007.

As the PCMH model of health care gains prominence, a number of organizations are developing or offering medical home recognition or accreditation programs. The new guidelines aim to ensure some standardization among those accreditation programs while encouraging a focus on the key elements of the PCMH.

"If we are to know the value of a patient-centered medical home's accreditation, we need to be assured the accrediting program itself has met appropriate standards," said Roland Goertz, MD, MBA, FAAFP president of the AAFP. "These guidelines help define those standards for accreditation programs."

Three nonprofit groups - the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC (formerly known as the Utilization Review Accreditation Commission) - already have established recognition, accreditation, or other relevant programs. One other nonprofit organization - The Joint Commission - plans to have a program in place by the middle of this year.

The AAFP, AAP, ACP and AOA developed the 13 guidelines to describe important elements considered essential for effective PCMH recognition programs. The guidelines say that programs should attempt to assess all of the primary care domains outlined by the Institute of Medicine - comprehensiveness, coordination, continuity, accessibility, and patient engagement and experience. According to the guidelines, all PCMH recognition or accreditation programs should:

1. Incorporate the Joint Principles of the PCMH;
2. Address the complete scope of primary care services;
3. Ensure the incorporation of patient and family-centered care emphasizing engagement of patients, their families, and their caregivers;
4. Engage multiple stakeholders in the development and implementation of the program;
5. Align standards, elements, characteristics, and/or measures with meaningful use requirements;
6. Identify essential standards, elements, and characteristics;
7. Address the core concept of continuous improvement that is central to the PCMH model;
8. Allow for innovative ideas;
9. Acknowledge care coordination within the medical neighborhood;
10. Clearly identify PCMH recognition or accreditation requirements for training programs;
11. Ensure transparency in program structure and scoring;
12. Apply reasonable documentation/data collection requirements; and
13. Conduct evaluations of the program's effectiveness and implement improvements over time.

The AAFP, AAP, ACP and AOA have sent the joint guidelines to NCQA, AAAHC, The Joint Commission and URAC to encourage their use in the development, implementation, and evolution of their PCMH programs.

"The AOA is honored to join with the other primary care physician organizations in support of new guidelines for PCMH recognition programs. Adoption of these principles will ensure that PCMH recognition programs meet a minimal set of standards, thus providing physicians reassurance that their practice recognition program is consistent with others in the marketplace," said Karen J. Nichols, DO, president of the American Osteopathic Association.

ACP President J. Fred Ralston Jr., MD, FACP emphasized, "The consideration of these joint guidelines for PCMH recognition progams will help ensure that recognized practices truly provide patient-centered care that is effectively integrated and of high quality."

"The AAFP is pleased to join our medical specialty colleagues in outlining guidelines for PCMH recognition and accreditation programs," Goertz said. "With multiple organizations accrediting or recognizing medical homes, it's important to have guidelines to evaluate these programs."

"The AAP urges adoption and support of these guidelines by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families," said O. Marion Burton, MD, FAAP, president of the AAP.