Picture1In 2013, The National Committee for Quality Assurance (NCQA) revealed their leading-edge Patient-Centered Specialty Practice Recognition Program for improving specialty care. The program stems from the country’s most popular Patient-Centered Medical Home model and branches out into the Medical Neighborhood.

NCQA engaged a twenty-two member committee that included medical professionals from practices, physician groups, medical associations, health plans, and employer and consumer group representatives to develop a strong set of standards and guidelines that build on the achievements of their Patient-Centered Medical Home Recognition Program.

According to NCQA, the Patient-Centered Specialty Practice Recognition Program recognizes practices that “demonstrate patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement.”

The PCSP Recognition Program will help specialty practices function within “accountable care” models, and prepare them to provide higher-quality and coordinated care. PCSP recognition will also help improve the cost of care to be ready for Medicare’s Value-Based Payment Modifier that will begin January 1, 2017 for physician solo practitioners and physicians in groups with two or more eligible professionals.

Key components of a PCSP are:

• Patient-Centered Care
Delivering specialty care that focuses on the patient’s preferences and needs; while collaborating with family and caregivers, and respecting the patient’s culture and values.

• Coordinated Care
The PCSP proactively coordinates and shares and tracks information among the patient’s primary care providers, and with all specialists and healthcare facilities that are involved in the patient’s care. Well-designed care coordination will improve patient experiences and decrease unnecessary redundancies that coincide with substandard care coordination.

• Accessible Services
The PCSP seeks to provide accessible services through minimizing wait times, same-day appointments, receiving clinical advice during regular office hours and after-hours and providing information and services through a secure electronic system.

• Quality and safety
The PCSP model is committed to providing safe, high-quality care through clinical decision-support tools, evidence-based care, self-management support, performance measurement, and population health management. Sharing quality data and improvement activities also contribute to a systems-level commitment to quality.

What are some of the benefits of becoming a Patient-Centered Specialty Practice?

1. Provides Higher Quality Patient-Centered Care
2. Lowers Health Care Costs
3. Reduces Waste from Poor Coordination of Care
4. Produces Better Outcomes and Patient Care
5. Improves Care Coordination & Communication between Specialist, Patient, and PCP
6. Enhances Patient Experiences
7. Prepares Practice to meet Quality Measurements with Value-Based Purchasing
8. Attracts More Patients by “Standing Out” with a PCSP Recognized Practice

In the February 2015 article, “Physician Reimbursement Changes: 5 Ways to Gain Control”, by Physicians Practice, Susanne Madden, president and CEO of practice-management consulting firm The Verden Group, recommended that practices should “pursue recognition as a Patient-Centered Medical Home or a Patient-Centered Specialty Practice, as more payers are offering related reimbursement increases or monthly care coordination payments.” Payers are currently recognizing and incentivizing PCMH Programs, and it is widely-anticipated that Patient-Centered Specialty Practices will follow in those same footsteps.

Regardless of how PCSP certification affects the bottom line, practices that undertake the process have their work cut out. Small practices in particular often struggle to navigate the complex and time-consuming process with limited resources.

But even if you don’t have a hospital or large-group infrastructure to help you manage the process, you needn’t go through the journey alone. Kentucky REC provides PCSP coaching and support to practices large and small at reasonable prices. The REC is a National Committee for Quality Assurance (NCQA) Partner in Quality (PIQ) with several NCQA-certified subject matter experts on staff. Contact us to learn more about how we can help you transform your practice!

NCQA: Patient-Centered Specialty Practice Recognition
CMS: Value Based Modifier
Physicians Practice: Physician Reimbursement Changes: 5 Ways to Gain Control