Patient-Centered Specialty Practice for Specialists

While still in its infancy, word about the National Committee on Quality Assurance's (NCQA) medical home program for specialists is spreading fast. The program was released last March and appears to be gaining considerable momentum. We receive inquiries daily from practices asking how we can assist them with meeting the program's standards; from gastroenterologists, oncologists, nephrologists, orthopedists, even ophthalmologists.

Unlike the primary-care Patient-Centered Medical Home (PCMH) program that has taken several years to become firmly established, it appears that specialists are "early adopters" of this new similar program - Patient-Centered Specialty Practice (PCSP) - designed especially for them.

About the PCSP program

The Patient-Centered Specialty Practice Recognition Program "recognizes specialty practices that have successfully coordinated care with their primary-care colleagues and each other, and that meet the goals of providing timely access to care and continuous quality improvement," according to the NCQA website. What this really means is this - specialists undertaking the program must comply with a rigorous framework designed to ensure that testing, referrals, and patient care are all highly coordinated and that communication between specialists, primary-care physicians, and facilities is efficient, timely, and meaningful. As you can imagine, it takes a lot of time and effort for practices to meet these standards. Transitioning to the new framework takes at least six months and often much more than that, particularly if you are a large practice with multiple locations (plan on at least a 12-month project in those cases).

Early adopters

So why would specialists seem so eager to sign up for the expense, hard work, and change that achieving recognition would bring them? Based on our clients' perspectives it appears to come down to three things:

1. It's a great way to differentiate from other practices.

There is considerable competition in some markets and specialists are looking for ways to provide better care to attract more patients, more referrals, and better-paying contracts. Primary care practices that have achieved PCMH status are looking for specialists that help them to better coordinate patient care; making specialists that achieve PCSP recognition effective "partners" in that care.

2. Value-based purchasing is here.

Payment for services is quickly moving away from being encounterbased and toward being outcomebased. Specialists are seeking a model in which to better understand how to comply with CMS programs, how to meet commercial insurers' performance programs (such as bundled episodes of care, shared cost savings, and performance payments), and are getting ready for working with accountable care organization (ACO) models. The PCSP model offers them a way to more readily and easily comply with meeting quality measurements, helps them to better manage population health data tracking, and allows them more control over how these programs need to work within their practices.

3. Better patient care and outcomes.

Many of our clients are seeking ways to focus on their most prevalent conditions and procedures in order to provide better care and outcomes. Meaningful use compliant EHRs have helped with tracking, reporting, and population management, but many physicians are seeking a more clinical focus. PCSP provides a way to do exactly that by allowing providers to focus on specific conditions and establish improvement cycles to work toward better outcomes.

Should you sign up?

While many insurance companies across the country recognize and pay for PCMH programs, the PCSP program is still very new. So far, 310 specialists across the country have achieved PCSP recognition and many more are in process. But as this represents only a small number of specialists so far, insurers have not yet had demand to develop PCSP payment models. However, the PCSP program offers insurers a great way to reward quality across networks, without having to build out individual programs for each specialty. I therefore expect to see PCSP-based payments begin to roll out by 2015. Specialists may do well to position themselves to take advantage of these expected future contracts as soon as they begin by starting their PCSP projects without delay.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She is also chief operating officer for the National Breastfeeding Center, and cofounder, Patient Centered Solutions. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.