The National Committee for Quality Assurance has launched a new program to recognize the role of specialists in the patient-centered medical home.
The program, which launched March 25, evaluates how well specialists do in ensuring access, communication, and care coordination for their patients. The "Patient-Centered Specialty Practice Recognition" program is based on the concept of the medical home "neighbor" – first developed by the American College of Physicians – and follows the same model as the NCQA’s patient-centered medical home recognition program for primary care physicians.
Most patients see multiple physicians, so a program to help specialists see how they are doing on care coordination is essential, Margaret E. O’Kane, NCQA president, said during a press conference.
NCQA estimates that the typical primary care physician coordinates with 229 physicians across 117 different practices. And the average Medicare beneficiary sees seven physicians and fills more than 20 prescriptions each year.
"The opportunity for gaps to emerge among all those complex relationships – or for things to happen that really are in conflict with each other – obviously is great," Ms. O’Kane said.
Specialists who take on a key management role for patients, including oncologists, cardiologists, and endocrinologists would be prime candidates for the recognition, according to NCQA.
Under the program, specialists will be required to meet several standards for care coordination and information sharing:
• Track and coordinate referrals. Specialists will be required to create referral arrangements and care plans with primary care practices. They will also need to monitor the communication to make sure information is being received and that it meets the needs of all the providers.
• Provide access and communication. Specialists need to provide 24/7 access, either through in-person visits or electronically.
• Identify and coordinate care for patient populations. Specialists must track their patients over time and across clinical encounters.
• Plan and manage care. This standard includes previsit planning, creation of care plans, and medication management and reconciliation.
• Track and coordinate care. This involves tracking laboratory and radiology tests, hospitalizations, and emergency department visits.
• Measure and improve performance. This standard measures clinical quality, utilization, care coordination, and patient experience.
The program requires specialists to complete an online survey and submit documentation on their ability to meet the standards.
The NCQA offers three levels of recognition. Level 1 is awarded to practices that meet the minimum score of 25 points out of 100 and all of the "must pass" standards. Practices who score higher can qualify for higher levels of recognition. The recognition status lasts for 3 years.
Dr. John Cox, a Dallas oncologist and member of the NCQA advisory council that developed the standards, said his practice interacts with more than 500 referring physicians each year and too often does not have necessary information from other providers when they sit down to work out care plans with their patients.
"We do a terrible job of really coordinating our efforts," he said.
Dr. Cox said he and other specialists are eager for the kind of tool the NCQA is offering.
"I think a lot of specialists are somewhat thirsty for having an external yardstick by which we can measure and aspire to get our practices up to speed," he said.
NCQA officials foresee that specialists who achieve this recognition potentially could see a financial benefit. Ms. O’Kane said payers might use the NCQA recognition as the basis for offering care coordination payments to specialists as part of pay-for-performance programs.