2014 - PCMH1A

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The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:

1.A.1 Providing same-day appointments for routine and urgent care. (CRITICAL FACTOR)

To show that they provide same day appointments, the practice will need to document their process for using sick call blocks to reserve time for sick patients every day. They also need to produce a report from Partner that shows these blocks in the schedule or shows how much total time was reserved for sick appointments and how much was actually used.

Here are some samples that might be useful:

Description	Example/Screenshot/Documentation	Source	Date Added
Specific Scheduling Policies and Procedures	Policy Part 2	TPC	03/25/13
PCC Examples for providing availability for same day appointments	PCC Documentation re: same day appointments	PCC	07/02/14

1.A.2 Providing routine and urgent-care appointments outside regular business hours.

The practice schedules appointments outside a typical daytime schedule. For example a practice may open for appointments at 7am or remain open until 8 pm on certain days or it may be open two Saturdays each month.

Providing extended access does not include:

• Opening daytime appointments when a practice would otherwise be closed for lunch (on some or most days).
• Opening daytime appointments when a practice would otherwise close early (e.g., a weekday afternoon or holiday).

You must produce a documented process for arranging access outside of regular business hours. You should also produce a report from Partner 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

1.A.3 Providing alternative types of clinical encounters

An alternative type of clinical encounter is a scheduled meeting between patient and clinician using a mode of real-time communication in lieu of a traditional one-on-one in-person office visit; for example, standalone communication or a combination of telephone, video chat and secure instant messaging. Group visits where the patient is one of several patients scheduled for care and education at the same time also qualifies as an ‘alternative type of clinical encounter.’ Unscheduled alternative clinical encounters, including clinical advice by telephone and secure electronic communication (e.g., electronic message, Web site) during office hours do not meet the requirement.

1.A.4 Availability of appointments

NCQA reviews a documented process defining the practice’s standards for timely appointment availability (e.g., within 14 calendar days for physicals, within 2 days for follow-up care, same day for urgent care needs) and for monitoring against the standards. The practice must produce a report with at least five days of data showing appointment wait times compared with defined standards

You'll need to document that you've set your own standards for what you consider to be timely appointment availability for different appointment types. I've mostly seen practices report on just those appointment categories mentioned: "Physicals (well visits), Follow-up Care, Urgent Care (sick visits)". One common way to measure appointment availability is to determine when the third next available appointment is for each appointment type. So consider setting a standard based on that, like so...

Appointment Type	# days until 3rd next available appointment
Well Visit	14days
Followup Visit	3 days
Sick Visit	0 days

... setting the # days until 3rd next available appt to be what you consider to be an adequate wait time.

For this factor, NCQA is really just wanting you to compare what you consider to be adequate appointment availability to what your actual appointment availability is like.

Description	Example/Screenshot/Documentation	Source	Date Added
Example table of appointment wait times for 5 days	1A4.pdf	PCC	5/17/16

1.A.5 Monitoring no-show rates

The practice needs a documented process for monitoring scheduled visits and a report from a recent 30-calendar-day period showing number of scheduled visits; number of patients actually seen, number of no-shows; and a calculated rate using scheduled visits as the denominator and patients seen as the numerator.

Description	Example/Screenshot/Documentation	Source	Date Added
PCC's Dashboard includes data showing your practice-wide and provider-specific no-show rates	Missed Appointment Rate data reported in the Dashboard	PCC	05/27/15

1.A.6 Acting on identified opportunities to improve access

NCQA reviews a documented process for selecting, analyzing and updating its approach to creating access to appointments that considers appointment supply and patient demand by:

• Including criteria for selecting areas of focus.
• Describing how the practice monitors areas of focus.
• Describing how the practice sets targets for improvement.
• Specifying how often criteria for creating greater access to appointments are revisited.
• Outlining when targets may be adjusted.

NCQA reviews a report showing the practice has evaluated data on access, selected at least one opportunity to improve access and took at least one action to create greater access.

Description	Example/Screenshot/Documentation	Source	Date Added
Use PCC's notify tool to send appointment reminder messages to patients with upcoming appointments. With notify, messages can be sent by phone, email, or text and appointments can be auto-confirmed. A notification log can be monitored to measure how often reminder messages are received by patients.
Develop a no-show policy communicating to patients your expectations and consequences for missed appointments. Also consider creating scripts that help staff to respond to missed appointments kindly and with patient care in mind while still communicating the importance of not missing scheduled appointments.