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Standard 7 - PPC - PCMH - Frequently Asked QuestionsPhysician Practice Connections - Patient Centered Medical Home (PPC-PCMH)Standards & Guidelines
Standard 7: Referral Tracking - "The practice uses a paper based or electronic system to assist practitioner referrals designated as critical until the specialist or consultant report returns to the practice."
Q. Is it necessary to designate all referrals?
A. Clinics should designate all referrals as critical or otherwise and then
track the following 4 elements:
1. Origin
2. Clinical Details
3. Tracking Status
4. Administrative Details
Q. How is a Critical Referral determined?
A. "A critical referral is determined by the physician to be important to the
treatment of the patient or indicated by practice guidelines. An
example would be a referral to a breast surgeon for examination of a
possibly cancerous lump or a referral to a mental health professional for
a patient identified with depression or suicidal ideation. As many patients
with special health care needs receive care regularly from a specialist or
consultant, it is essential that the practice remain engaged in that care. The
practice should establish an effective mechanism of timely communication
with the specialist or consultant either by phone, fax or e-mail in addition to
written correspondence."
Q. For some practices the problem is more than a few specialists are slow to
send back reports, if they even do so. That means extra phone calls and
follow-up. The common thread here is where does the practice find the
staff to do this?
A. I encourage the clinic to focus on what is going well. Remember there are 4
components to this element, tracking of the origin, basic clinical details,
tracking of the referral and outcomes and general administrative details.
Our clinics were only able to get 3 of the 4. The clinic only needs to track 1
of the 4 to pass the must pass element.
National NCQA site FAQ - Click Here
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