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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

New Program Recognizes Specialists, The People in Your (Medical) Neighborhood

by Richard Kwong, Quality Performance Manager

Yesterday, The National Committee for Quality Assurance (NCQA) announced 2016 standards for their Patient-Centered Specialty Practice (PCSP) recognition program.  In doing so, they’ve invited the 472,335 specialists in the United States to take on a larger role in the medical neighborhood. athenahealth is proud to announce that it is ready to support all 17,000 specialists on our network as a pre-validated vendor with our new PCSP Accelerator Program.


Since 2011, athenahealth has been pioneering advanced support for our primary care physicians and the  Patient-Centered Medical Home (PCMH) recognition through a pre-validation program with NCQA, the most widely used and fastest-growing PCMH recognition program.  With expanding mandates for all providers of all specialties to embrace new models of care and better coordinate care, athenahealth is thrilled to now provide new support for our specialists in a similar model of care and recognition program.

NCQA’s PCSP 2016 recognition program recognizes and rewards specialty practices for streamlining referrals, coordinating evidence-based care, and putting the patient and family at the center of care.  Like its primary care counter-part, PCSP will guide specialists in transforming their practices to play a larger role in the medical neighborhood and position them for success in value-based reimbursement.

Why Now?

It’s time for the 472,335 specialists in the United States to take on a larger role in the medical neighborhood. With the growth of Accountable Care Organizations (ACOs) nationally, as well as the implementation of bundled payments, providers everywhere—regardless of specialty—are experiencing new mandates to coordinate care for patients.

In a 2011 white paper, the Agency for Healthcare Research suggested that “a well-functioning medical neighborhood requires basic communication and coordination” between primary care and specialty clinicians in areas as various as care planning; patient clinical background and care goals; and overall assistance to patients navigating the health system.  Yet the literature has consistently found the specialty-primary care relationship fragmented.  A 2011 review of specialty referrals in Milbank Quarterly identified breakdowns across the entire referral chain, finding both critical medical and referrals-related information missing.[1]  A recent study in the Archives of Internal Medicine corroborates this view, revealing that only 35% of specialists reportedly receive notifications about their patients’ histories and reasons for consultation, despite the fact that 70% of primary care physicians claim to regularly send this information. The inverse also appears to be true: 80% of specialists report sending results back to the referring physician, yet only 62% of these referring physicians report receiving them.[2]

It is clear that specialists no longer practice in a vacuum. Specialists are increasingly held financially accountable for patient outcomes which are in turn reliant on extended patient care teams. As Dr. Fratkin recently observed on this blog, bundled payments for knee and joint replacements going into effect today, April 1st, will require alignment across hospitals, physicians, and post-acute providers. New models of care delivery like PCSP, which facilitate the integration of the specialist into medical neighborhoods, are part of the solution. Like PCMH, the PCSP model of care is expected to automatically qualify for the Merit-based Incentive Payment System (MIPS) Clinical Practice Improvement Activity (CPIA) credit.

We’re Ready to Help

At athenahealth, we believe that new models of care like PCMH and PCSP are just the thing to help providers deliver high-quality care that is coordinated, continuous, and cost-effective.  We also believe your health IT services should put you on the path to success.

That’s why athenahealth is excited to announce our new PCSP Accelerator program, designed to support all 17,000 specialists on our network. Specialist clients are eligible to receive up to 23.5 auto-credits from athenahealth towards their application to NCQA, simply for using our suite of network-enabled services. Practices can also collect up to an additional 24.75 points by following our NCQA-approved practice support workflows.  This means we can offer our clients a potential combined 48.25 points, significantly lowering the threshold for Level 3 recognition.  We are pleased to be one of the first three health IT vendors pre-validated by NCQA under its Early Adopter opportunity.

The athenahealth PCSP 2016 Accelerator Program gives specialty practices of all sizes the support they need to reorient themselves to this new model of care.  athenahealth is committed to lessening the burden on providers of all specialties as they work to espouse open access, patient activation, continuity of care, and quality outcomes in their practices.  Our pre-validation by NCQA is an indication of just how well-suited network-enabled services are to this pursuit.  Tell us your thoughts on PCSP and how we can support you and your practice!



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