2017 - Competency AC-A

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Competency A: The practice seeks to enhance access by providing appointments and clinical advice based on patients’ needs.

AC 01 (Core): Assesses the access needs and preferences of the patient population

The practice evaluates patient access from collected data (i.e., survey, patient interviews, comment box) to determine if existing access methods are sufficient for its population. Alternative methods for access may include evening/weekend hours, types of appointments or telephone advice. Documented process and evidence of implementation is required.

AC 02 (Core): Provides same-day appointments for routine and urgent care to meet identified patient needs

The practice reserves time on the daily appointment schedule to accommodate patient requests for a same-day appointment for routine or for urgent care needs. The time frames allocated for these appointment types are determined by the practice and based on the needs of the patient population, as defined in AC 01.

As evidence of implementation, a report should be provided that includes a 5-day schedule to demonstrate the appointments are available or a report demonstrating which same-day appointments were used.

Description Example/Screenshot/Documentation Source Date Added
PCC Examples for providing availability for same day appointments PCC Documentation re: same day appointments PCC 09/06/17

AC 03 (Core): Provides routine and urgent appointments outside regular business hours to meet identified patient needs

The practice recognizes that patients’ care needs are not confined to normal operating hours, and therefore offers routine and urgent care appointments outside typical business hours. For example, a practice may open for appointments at 7 a.m. or remain open until 8 p.m. on certain days or on open on alternating Saturdays. A practice that cannot provide care outside regular business hours (e.g., a small practice with limited staffing) may arrange for patients to schedule appointments with other facilities or clinicians. The practice may use an urgent care center in the same health system for urgent and routine appointments outside regular business hours, or an urgent care center in the community that has access to patient records.

Providing extended access does not include:

  • Offering appointments when the practice would otherwise be closed for lunch.
  • Offering daytime appointments when the practice would otherwise close early (e.g., a Friday afternoon or holiday).
  • Utilizing an ER or urgent care facility that is unaffiliated with the practice.

You must produce a documented process for arranging access outside of regular business hours. You should also produce a report from of appointments restricted to appointment times happening outside of regular business hours. The report must include at least 5 days of appointment data.

Description Example/Screenshot/Documentation Source Date Added
The srs "Appointment Stat Report - Day of Week/Reason" in the "Scheduling Reports" category can be used. Restrict this to show only appointments for after-hours times when the office is not open (Sat, Sun after 12:00pm for example). Be sure to exclude cancelled/missed appointments Example of PCC report showing appointments scheduled outside regular business hours PCC 05/27/15

AC 04 (Core): Provides timely clinical advice by telephone

Clinicians return calls in a time frame determined by the practice. Clinical advice must be provided by qualified clinical staff, but may be communicated by any member of the care team, as permitted under state licensing laws. NCQA reviews a report summarizing the practice’s expected response times and how it monitors its performance against standards for timely response. The practice must present data on at least 7- days of such calls.

A documented process for providing timely advice to patients over the phone is also required to meet this factor. PCC EHR clients should record phone calls as phone encounters. For calls that need a callback, a phone task should be created with an appropriate task type and this task should be completed once the phone call has been initially responded to. As documentation for this factor, users can generate a report of phone calls and response times using the "Phone Encounter Performance Report" in the EHR. This report can be used as a call log showing each phone call including response time to complete the first associated task.

Description Example/Screenshot/Documentation Source Date Added
PCC Documentation showing how to provide timely clinical advice during and after office hours Providing timely clinical advice PCC 7/3/14

AC 05 (Core): Documents clinical advice in patient records and confirms clinical advice and care provided after-hours does not conflict with patient medical record

The practice documents all clinical advice in the patient record, whether it is provided by phone or by secure electronic message during office hours and when the office is closed. If a practice uses a system of documentation outside the medical record for after-hours clinical advice, or provides for after-hours care without access to the patient’s record, it reconciles this information with the medical record on the next business day.

The evidence includes two examples of documenting the clinical advice:

  • 1 example of advice documented during office hours
  • 1 example of advice documented after normal business hours as defined in AC 03

The reconciliation evaluates if clinical advice or care provided after-hours conflicts with advice and care needs previously documented in the medical record and addresses any identified conflicts.

Description Example/Screenshot/Documentation Source Date Added
PCC documentation showing how to document clinical advice How to document clinical advice PCC 7/3/14

AC 06 (1 Credit): Provides scheduled routine or urgent appointments by telephone or other technology-supported mechanisms

The practice uses a mode of real-time communication (e.g., a combination of telephone, video chat, secure instant messaging) in place of a traditional in-person office visit with a clinician. The practice provides a report of the number and types of visits in specified time period.

Unscheduled alternative clinical encounters, including clinical advice by telephone and secure electronic communication (e.g., electronic message, website) during office hours do not meet the requirement. An appointment with an alternative type of clinician (e.g., diabetic counselor) does not meet the requirement.

AC 07 (1 Credit): Has a secure electronic system for patient to request appointments, prescription refills, referrals and test results

Patients can use a secure electronic system (e.g., website, patient portal) to request appointments, prescription refills, referrals and test results. The practice must demonstrate at least two functionalities.

Description Example/Screenshot/Documentation Source Date Added
Description of how PCC's Patient Portal allows for patient request for appointments, Rx refills, referrals, or test results Document describing PCC Patient Portal functionality for patient requests PCC 09/06/17

AC 08 (1 Credit): Has a secure electronic system for two-way communication to provide timely clinical advice

Description Example/Screenshot/Documentation Source Date Added
PCC Documentation showing how to use portal messaging and track response time to portal messaes Providing timely clinical advice via secure messages PCC 9/6/17

AC 09 (1 Credit): Uses information about the population served by the practice to assess equity of access that considers health disparities

Knowing whether groups of patients experience differences in access to health care can help practices focus efforts to address the inequity. The practice identifies health disparities and evaluates whether those disparities are impacted by access to care differently for underserved patient groups. An example of how a practice may demonstrate this is through a report of how an identified group of patients has lower rates of access than the general patient population.

Healthy People 2020 defines health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”