Specialties other than primary care can, and should, be included in clinical practice transformation efforts – particularly those surrounding patient-centered care. You’ve probably heard comments from specialists that they’re relieved all the patient-centered talk only applies to primary care. You’ve probably heard the same thing about clinical practice transformation efforts. Well, the truth is they don’t have to be, nor should they be. We will present four reasons for specialists to pursue Patient Centered Specialty Practice (PCSP) recognition.
Why should I pursue PCSP recognition?
Altruistically, specialists should pursue PCSP recognition to ensure they provide the best possible patient care and customer service. For those who feel they already do this, formal recognition from an organization like NCQA becomes a way to prove to yourself and to others – like referring providers, patients, and external organizations, including payers – that you’re achieving that.
Alternatively, if there is room for improvement, the PCSP standards will help transform the practice into one predicted to succeed in both fee-for-service and value-based care environments. Pursuing recognition has been shown to enhance revenue through increased referrals (patients and referring clinicians will love you) and decreased costs (avoiding redundancies and the risk of litigation), while continually improving customer service and patient outcomes.
If you are part of a multi-specialty group or clinically-integrated network, all specialties can be transforming care together, utilizing a common framework that builds similar policies and procedures, creates common expectations, and generates a shared culture. The process helps to form a more cohesive, collaborative group with higher levels of engagement, satisfaction, and retention. These factors come together to create the Holy Grail practice environment.
Lastly, working toward PCSP recognition will satisfy MIPS Improvement Activity performance category activities, which are geared toward patient-centered care concepts. Ultimately, achieving and maintaining NCQA PCSP recognition automatically garners full credit (the highest possible score) for that MIPS performance category. A true two-for-one proposition.
What does it take to be recognized as a PCSP?
NCQA realizes that non-primary care specialty practices accommodate a range of patient relationships, from a single consultation episode to lengthier patient evaluation and treatment, actual co-management and, sometimes, temporary or permanent care management (some oncology or cardiology patients for example). Thus, the recognition standards must account for this wide range of activity. The 2013 standards were revised in 2016, but still emphasize close working relationships and communications with primary care and other referring clinicians, enhanced patient access and communications in a team-based care environment, evidence-based, coordinated care enhanced by tracking and decision support software, and continually improving care and outcomes.
Like historic PCMH recognition, PCSP recognition can occur in three levels based on the degree to which the elements and factors associated with the six (6) standards are achieved. Practices must accrue at least 25 points (out of a possible 100), including six (6) “must pass” elements, to achieve the base level recognition (Level 1). Subsequent recognition levels are achieved at 50 points (Level 2) and 75 points (Level 3). You can begin as a neophyte and still achieve recognition that can progressively be built upon.
Where did this patient-centered talk come from?
The tenets of patient-centered care are applicable for most specialty practices – even though the foundations for patient-centered medical homes arose in the primary care realm. The term was first used by AAP (circa 1967), was codified in the 2007 consensus statement generated by primary care specialty organizations (Joint Principles of the Patient-Centered Medical Home by the ACP, AAFP, AAP, and AOA), and has received the most press in application to primary care delivery.
Another foundational document, the 2001 Institute of Medicine treatise “Crossing the Quality Chasm: A New Health System for the 21st Century,” listed the following as core elements applicable to all aspects of patient care:
- Care based on continuous healing relationships
- Care based on patient needs and values
- Patient as source of control … and responsible for his/her health
- Patient access to medical information and clinical knowledge
- Evidence-based decision making
- Decreased variability of care
- Patient safety
- Transparency of information
- Anticipation of needs
- Continuous decrease in waste
- Cooperation among clinicians
The first formal criteria (or standards) developed to define patient-centered care targeted primary care delivery. Organizations like NCQA first developed applicable criteria in 2003, with the PCMH designation arising in 2008. The standards have progressively advanced in sophistication and pertinence. By 2015, NCQA was “recognizing” more than 11,000 PCMH practices involving more than 52,000 clinicians. The published, proven benefits of operationalizing the PCMH standards include:
- Improved clinical outcomes
- Lower inpatient admissions
- Reduced ER visits and hospital readmissions
- Lower cost (especially for complex chronic conditions)
- Better engaged and happier patients
- Increased staff satisfaction
References available upon request
However, these benefits and others (such as better patient outcomes, enhanced value-based performance, increased referrals, heightened operational efficiency, significant cost reduction/avoidance, and superior risk mitigation) were felt to be equally applicable to other specialty practices. In 2013, NCQA introduced a recognition program for these practices – PCSP (Patient Centered Specialty Practice) – based on the same foundational tenets. By 2015, NCQA had recognized 84 specialty practices involving more than 600 clinicians. The standards were updated in 2016 to build on lessons learned.
To learn more about this opportunity to transform care delivery and improve outcomes for specialty practices, follow this link www.ncqa.com.
[Note: NCQA has a third recognition category called Patient Centered Connected Care (PCCC) which applies to urgent care, retail clinics, rehab, and other practices. More information can be found at www.ncqa.com.]
Terry McWilliams, M.D., Chief Clinical Consultant, TMcWilliams@HSGadvisors.com, (502) 614-4292