New Recognition Standards for Specialty Practices Emphasize Coordination With Primary Care

New Recognition Standards for Specialty Practices Emphasize Coordination With Primary Care

By the Innovations Exchange Team


Under new standards to be issued by the National Committee for Quality Assurance (NCQA), medical specialty practices that successfully coordinate care with primary care practices and with each other may earn recognition as a patient-centered specialty practice. The standards that the NCQA plans to release in March 2013 will help specialty practices develop systematic processes that should ultimately improve patient outcomes and reduce hospital and emergency department visits. The program will recognize specialty practices that coordinate care, provide timely access, improve transitions of care, reduce duplication of tests, and work toward continuous quality improvement. The Innovations Exchange discussed the new NCQA recognition program with Johann Chanin, RN, MSN, Director of NCQA's Product Development, and David Eagle, MD, President of the Community Oncology Alliance, which represents one of many medical specialties interested in the new recognition program.

Innovations Exchange: How does the new program intersect with Federal Meaningful Use objectives?

Johann Chanin, RN, MSN: Practices that receive the NCQA's specialty practice recognition will be better prepared to meet federal Meaningful Use Stage 1 and Stage 2 objectives for health information technology. The NCQA standards are aligned with the Meaningful Use objectives to support the use of information technology to improve patient care, communication, and information exchange. However, specialty practices are not required to use certified electronic health record (EHR) technology, or even have an EHR system, to receive NCQA recognition. For example, a practice with a free-standing electronic prescribing system or an electronic patient billing system could potentially meet the standards and receive recognition.

How do the new specialty standards differ from NCQA's Patient-Centered Medical Home standards?

Chanin: The new specialty practice recognition standards will replace the Physician Practice Program ® that the NCQA released in 2006 for primary care and specialty practices that emphasized systematic processes to improve the health of patients. The new standards, like the NCQA's 2011 Patient-Centered Medical Home standards, specify expectations for clinical care teams to provide timely access to care and implement continuous quality improvement. However, a significant difference is that specialists who seek recognition under the new standards must establish written processes for managing referrals, including information exchange and transitions of care from primary care physicians and other clinicians. The referral requirements include:

  • Communication methods with clinicians as well as with the patient/family/caregiver about the specialist's plan of care
  • The co-management or care transition strategy for selected patients
  • Confirmation of receipt and acceptance of referral, with date and time of the patient appointment
  • Specific information about patients that specialists need from referring clinicians, and
  • The timing and content of the referral response.

Will the referral requirements improve care coordination and communication between primary care physicians and specialists?

Chanin: Yes, they should. However, these issues are longstanding. In a 2011 article in the Archives of Internal Medicine, “ Referral and Consultation Communication Between Primary Care and Specialist Physicians ,” the authors found that nearly 70 percent of primary care physicians reported that they usually sent information about the patient's history and reason for consultation, whereas only approximately 35 percent of specialists reported that they generally received such information. In addition, nearly 81 percent of specialists said they usually sent results to the referring physician, whereas only 62 percent of the primary care physicians said they generally received such information.

How do the new standards accommodate the roles that specialists play?

Chanin: The NCQA structured the referral standard to accommodate the range of specialists' roles including consultation, patient co-management, and primary care provider for a limited time.

David Eagle, MD: When patients are diagnosed with cancer and require treatment, medical oncologists become the primary physicians for that episode of care, including the coordination and communication of care. An example is a patient diagnosed with stage 3 colon cancer who is receiving 6 months of adjuvant chemotherapy. The medical oncologist becomes the chief contact for managing that person's care, which is what primary care physicians expect of us.

How will the performance of specialty practices be measured?

Chanin: The NCQA will require specialty practices to develop performance measures for care coordination results, clinical care, care that may impact health care costs, care of vulnerable populations, and timely access to appointments. In addition, specialists must survey patients and families about their experiences related to access, communication, coordination, and self-management support.

What is the Community Oncology Alliance doing to prepare practices for performance measures?

Eagle: The medical home model we are developing incorporates performance measures that can be used by practices, institutions and organizations that treat cancer patients. The measures look at resource utilization, the number of hospital admissions and emergency department visits per chemotherapy patient per year, the number of patient days in hospice care, survivorship, and end-of life discussions for patients with advanced stage cancer. These are elements we want to measure and obtain data on to establish benchmarks and compare practices against each other. If we can develop an oncology medical home model that can demonstrate high quality of care, it will create better value for the health care system.

What are the potential benefits of NCQA recognition for specialty practices?

Chanin: The new standards have been pilot tested with approximately 13 specialty practices. It's too early to know whether the specialty practice recognition program will save money or improve patient satisfaction or cost containment. However, the data that have been collected by a community oncology practice look promising. Specialty practices that gain NCQA's recognition may have a greater advantage or status with insurers. We believe that the standards will reduce the cost of care and that there will be better outcomes for patients. We hope providers will be happier with the methodical approach to the way they manage their practice.

The new specialty practice recognition standards and guidelines will be available March 2013 on NCQA's Web site at:

A profile of a community-based oncology practice that improved its processes using the patient-centered medical home model is available on the Innovations Exchange Web site at

About Johann Chanin, RN, MSN: Ms. Chanin is Director of Product Development for NCQA. She currently leads the development and implementation of NCQA's Patient-Centered Specialty Practice Recognition Program, to be released in March 2013. The Patient-Centered Specialty Practice Recognition Program standards are based on an extensive literature search, public comment, a pilot test, and an advisory panel of stakeholders. Ms. Chanin also led the development of NCQA's Patient-Centered Medical Home 2011 standards, and is an internal and external resource on NCQA's medical home standards.

About David Eagle, MD: Dr. Eagle is the current President of the Community Oncology Alliance and partner in Lake Norman Oncology, Mooresville, North Carolina. With broad experience in the management of both cancer and blood-related disorders, Dr. Eagle is board certified in internal medicine, hematology, and oncology.

Disclosure Statements: Johann Chanin, RN, MSN, disclosed that she receives payment as an NCQA employee and that NCQA received consulting fees/honorarium and travel support relevant to the work described in this article.

Dr. David Eagle reported having no financial interests or business/professional affiliations relevant to the work described in this article.

Publish Date: 03/13/13
Date Last Updated: 04/17/13

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