You want to receive PCMH recognition, but you don't know where to start. One question you may have is which accreditation to pursue or maintain. Do you go with NCQA recognition? Maybe The Joint Commission? How do the processes differ? To make your decisions easier, we've put together a comprehensive look at the benefits and process of The Joint Commission (TJC) PCMH Certification for Ambulatory Health Care Centers. 

Defining PCMH

The medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care. According to AHRQ, the medical home encompasses five functions and attributes: 

1. Comprehensive Care
2. Patient-Centered 
3. Coordinated Care 
4. Accessible Services 
5. Quality and Safety 

You may be wondering what the incentives are for achieving PCMH recognition. HRSA covers fees associated with PCMH, AAAHC, and TJC. The fees covered may be associated with initial accreditation and re-accreditation for ambulatory health care accreditation and PCMH recognition, initial, renewal, and add-on surveys. HRSA also rewards recognition through the annual Quality Improvement Awards for practices who have achieved PCMH recognition at one or more sites. 

Why should you consider The Joint Commission? 

The Joint Commission's Primary Care Medical Home (PCMH) certification is based on AHRQ's definition of a medical home, which includes these core functions and attributes: 

• Patient-centered care - Relationship-based care focused on the whole person and understanding and respecting each patient's needs, culture, values, and preferences. 
• Comprehensive care - A team of providers (may include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, mental health workers, social workers, and others) work to meet each patient's physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
• Coordinated care - Care is coordinated across the broader health care system, including specialty care, hospitals, home care, and community services and support. This is particularly critical during transitions between sites of care, such as when patients are discharged from the hospital.
• Superb access to care - Patients have access to services with shorter waiting times for urgent needs, enhanced in-person hours, around the clock telephone or electronic access to members of the care team, and alternative methods of communication such as email and telephone. 
• Systems-based approach to quality and safety - The PCMH uses evidence-based medicine and clinical decision support tools, engages in performance measurement and improvement, measures and responds to patient experiences and satisfaction, practices population health management, and publicly shares robust quality and safety data and improvement activities. 

What does TJC PCMH recognition look like? 

Who? 

• Sites who provide ongoing and continuous primary care
• Organizations currently accredited under the Ambulatory Care program and wishing to elect the PCMH option
• Organizations pursuing Ambulatory Care recognition 

When? 

• Elect the PCMH option as part of your next re-accreditation survey, or 
• Request an unannounced special extension survey specific to the PCMH option before the next re-survey. Compared to the Ambulatory survey, this extension survey will be shorter and focused only on PCMH requirements 

Cost? 

• There is an additional annual fee of $300 ($900 total for three-year accreditation cycle) for organizations adding the PCMH certification option 

How? 

• The PCMH requirements are incorporated into the ambulatory care on-site accreditation survey, including an enhanced tracer methodology process 
• Just like accreditation, the PCMH certification option applies to the entire organization, covers a three-year period, and is posted on the Quality Check portion of The Joint Commission's website 
• Recognition covers the entire organization/practice and does not have to be 100% implemented at all sites to achieve recognition

Benefits of TJC PCMH 

Some logistical benefits include stability in the requirements, flexibility in demonstrating the requirements, consistency in the process of accreditation, certifications being sustained with your Ambulatory cycle, and focus on transformation and sustaining PCMH with less emphasis on the recognition process. Organizations can also benefit from TJC PCMH certification since it creates a "work in progress" mentality. Certification is organizational, rather than site or physician based. In other words, all sites do not have to be 100% PCMH certified to achieve accreditation, but they do have to have a plan in place to get the remaining sites up to speed. TJC also encourages a top-down approach to transformation and pursuing PCMH cannot fall to one person to compose documentation. This ensures that PCMH is a true aspect of the organization's mentality. Other benefits include reduced documentation burden and being intuitive to true practice functions. 

Compare and Contrast 

Taking the step to achieve PCMH recognition is a big undertaking. While there are many pros and cons to each route you may take, it is important to review all the necessary information in order to make the right decision for your practice. 

Resources: 

• What you need to know about Joint Commission Primary Care Medical Home Fact Sheet
• AHRQ Defining PCMH 
• HRSA Accreditation and Patient-Centered Medical Home Recognition Initiative