NCQA Preps Specialists for Patient-Centered Medical Homes

Public comment wraps up this week on a major effort to extend the patient-centered medical home into specialty practices.

The National Committee for Quality Assurance (NCQA) is accepting public comments on its proposal until this Friday, July 13.

The Specialty Practice Recognition (SPR) 2013 standard will be published next March, but first, NCQA will consider all public comments on the proposal, and conduct pilot testing of the standard at 14 or 15 specialty physician practices, according to Johann Chanin, NCQA director of product development.

I wrote about NCQA's patient-centered medical home two weeks ago, and hosted a HealthLeaders Media webcast last month about the concept. This model brings much-needed comprehensive primary care, powered by technology, to patients dissatisfied with previously uncoordinated care between the many providers that patients often see in the course of a few months.

The patient-centered medical home is at the heart of the new standards and guidelines for Medicare Accountable Care Organization (ACO) accreditation. The program provides a road map for provider-led organizations to demonstrate reduced cost, improved quality, and enhanced patient experience. The expectation is that specialty practices within an ACO must be held to the same patient-centered care provided by primary care practices.

My research convinced me that this movement is still in its infancy. Not many physician practices have yet achieved NCQA certification as patient-centered medical homes. One sole practitioner I interviewed said the paperwork required is daunting for a small practice. But over time I expect this situation to improve.

NCQA rightly recognizes that continuity of care requires a closed loop of preserved information from primary practices to specialists and back again. And that requirement hasn't been there in the NCQA certification—until now.

Repeatedly, NCQA officials have heard it's been a one-way street, where referrals flow from the patient-centered medical homes to the specialists, but the specialists are under no obligation to respond back post-referral, leaving the primary care providers to wonder if the referral was received and what became of it.

In an Archives of Internal Medicine article, "Referral and Consultation Communication between Primary Care and Specialist Physicians," the authors found that primary care physicians reported sending the history or reason for consult information nearly 70% of the time, while specialists reported receiving such information only close to 35% of the time. Meanwhile, specialists claim to have sent consult notes or patient advice nearly 81% of the time, while PCPs claim receipt only 62% of the time.

Some specialists considered applying for patient-centered medical home status, but found it didn't make sense, since one wouldn't expect an oncologist, for example, to be keeping tabs on the patient's diabetes treatment or other unrelated specialty work.

So the new guidelines make it clear that the specialists should continue to provide their specialty care, but these guidelines close that loop I described by requiring certified specialists to indeed report back to the referring primary care practices.

Specialty Practice Recognition 2013 will replace the Physician Practice Connection guidelines published by NCQA in 2006. Back then, NCQA had not yet issued the original patient-centered medical home guidelines, so it is high time for revisions.

The latest NCQA moves draw upon work done by the American College of Physicians (ACP) and the Agency for Healthcare Research and Quality (AHRQ), including AHRQ's 2011 white paper, "Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms." It's well worth reading for a variety of ideas on how to enhance care coordination. For instance, the paper mentions the importance of strong community linkages that include both clinical and nonclinical services, such as personal care services, home-delivered meals, or school-based health care.

Although some of ACP's specialists have weighed in on the NCQA proposal and participated on NCQA's advisory committee, public comment lets other specialists weigh in, as well as health plans, consumer groups, and other interested parties.

According to Chanin, a literature search found that some specialists also feel they don't get all the information they need from primary care physicians in order to perform a really good consultation about a patient.

NCQA officials admit that it will be challenge to get specialists to participate in Specialty Practice Recognition. I am convinced that part of the answer is to educate the public in general about the quality that such NCQA certification represents. This would allow the power of the free market to weigh in, as patients presumably gravitate to those practices and specialists achieving this certification. As with many transitions currently occurring in healthcare, education is crucial. For now, make sure your input is a part of NCQA's latest efforts to improve its certification standards.