Slated for introduction in early 2013, the specialty program is designed to support patient-centered medical homes (PCMH) by making it easier for primary care doctors to obtain specialty care for their patients and to get feedback from specialists. The term medical home refers to a team-based approach, led by a primary care physician (PCP), that seeks to improve outcomes by providing comprehensive, continuous patient care.
NCQA will recognize practices that 1) coordinate care, 2) provide timely access to care, 3) use information technology to reduce duplicative tests, 4) improve communications with patients, and 5) support continuous quality improvement.
NCQA's proposed standards for specialty recognition are aligned with many of the proposed requirements for Meaningful Use Stage 2 in the federal government's electronic health record incentive program. But Patricia Barrett, VP of product development for NCQA, told InformationWeek Healthcare that to achieve lower levels of recognition, specialists will not have to be "meaningful users" of EHRs. That will be necessary only at the highest level of specialty practice recognition, she said. The standards encompass everything up to that level.
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The use of EHRs and other forms of health IT, she added, in itself doesn't prove that a specialist is trying to improve communications with referring physicians and patients. "But that technology is clearly an important way to enable the kinds of coordination and communication we think are necessary."
Some of the proposed standards are fairly prescriptive in this area: for example, specialty practices should be able to provide clinical advice by secure electronic messaging; give more than 50% of patients online access to their health information within 24 hours of a visit or within three business days of when the information is available to the practice; and ensure that at least 10% of patients view and can download their health information. The practices must also record patient demographic, insurance, and clinical information electronically. And they must use some kind of registry (though not necessarily electronic) to track care and send follow-up reminders to patients.
The program provides considerably more latitude in the area of referrals. The specialty practices should have a "written process for implementing and managing referrals with PCPs and other specialty practices." This process must include specifications for communications with primary care physicians and patients, including timely transmission of reports and lab results.
Specialists must send a summary of care report to another provider for at least 50% of referrals. In contrast to the Meaningful Use requirements, Barrett noted, this summary of care could be either electronic or a printed report. And the content of report could vary with the type of referral.
"We're trying to establish that there needs to be agreement between the referring provider and the specialist about the information that needs to be exchanged. Then you have to follow up to determine whether it does get exchanged."
Some specialists and primary care doctors from unrelated practices exchange data through health information exchanges. Asked whether this would be evidence of a specialist's efforts to coordinate care, Barrett replied, "Yes. Health information exchange can be a great tool for that collaboration to take place, to the extent that the information is already made available in that central data repository."
Barrett acknowledged that portions of the Meaningful Use Stage 2 proposal might change in the final rule, which the Centers for Medicare and Medicaid Services (CMS) will likely release this summer. Moreover, stage 2 will not go into effect until 2014, whereas the NCQA specialty program standards aligned with stage 2 will take effect in the first quarter of 2013.
To the extent that the final rule revises the stage 2 criteria, Barrett said, NCQA might reconsider the time frame of certain specialty program standards based on those requirements. But NCQA does not expect to delay the launch of the entire program, she added.
The public comment period on the proposed standards, which began June 11, ends July 6.
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