Beyond primary care

Specialists and medical societies are cheering the launch of a medical-home-type recognition program for specialty practices, an option they say will extend the emphasis on care coordination outside of primary care and ease communication among providers.

The Washington-based National Committee for Quality Assurance modeled the program after its patient-centered medical home recognition program, Margaret O'Kane, NCQA's president, said during a March 21 sneak preview webinar. That program kicked off in 2008 and now includes more than 26,000 clinicians at nearly 5,500 sites, she said.

Dr. Carol Greenlee, a Grand Junction, Colo.-based endocrinologist and vice chair of the American College of Physicians' Council of Subspecialty Societies, said the new designation would give specialty practices the opportunity to be recognized for their efforts. Greenlee co-wrote a 2010 ACP position paper calling for deeper coordination among patient-centered medical homes and their specialty and subspecialty “neighbors,” which served as a framework for the NCQA's program.

“This will give us the platform and tools to begin to have better handoffs and lead eventually to an integrated, shared care plan for the patient,” Greenlee said.

Dr. John Cox, a physician with Dallas-based Texas Oncology and editor-in-chief of the Journal of Oncology Practice, said NCQA's move was welcome news to specialty fields that have long wanted to be included in the medical-home movement.

“It always seemed weird to me that there was an emphasis on patient-centered medical homes in primary care without too much emphasis on the surrounding practices with which that practice needs to coordinate,” said Cox, who served on NCQA's 21-member specialty practice advisory committee. He called the specialty program, scheduled to launch March 25, a “yardstick” that practices can use to measure themselves and track progress.

“We do a terrible job of coordinating our efforts now,” Cox said, of oncologists. “Patients come in and they have the expectation that data will have been shared. Instead, we find ourselves saying we have to get this and this before we can even develop a care plan.”

Fifty-seven specialty practices have signed on as early adopters, including Western Slope Endocrinology, Greenlee's practice; Main Line Gastroenterology Associates, in Pennsylvania; and Northeast Indiana Urology, in Fort Wayne.

The prime targets are oncology, endocrinology, cardiology and other specialties that tend to take on care-management roles for patients, said Patricia Barrett, NCQA's vice president of product development.

But any specialty practice, even those that provide more episodic care, can benefit from the recognition, Cox said.

The specialty practice recognition program consists of six standards: tracking and coordinating referrals; providing access for and communicating with patients; identifying and coordinating patient populations; planning and managing care; tracking and coordinating care; and measuring and improving performance.

The measurement standard will, among other things, require practices to use electronic health records and to track performance on clinical quality and patient experience.