Patient-Centered Specialty Practice Frequently Asked Questions
Q: What is the NCQA Patient-Centered Specialty Practice Recognition program?
A: The PCSP recognition program for clinicians is designed to improve quality and reduce waste and poor patient experiences that result from poorly coordinated care. The program focuses on coordinating and sharing information among primary care clinicians and specialists. It requires clinicians to organize care around patients—across all clinicians seen by a patient—and to include patients and their families or other caregivers in planning care and as partners in managing conditions.
Q: Why is a specialist recognition program important?
A: This program recognizes specialty practices that successfully coordinate patient care and communicate with their primary care colleagues, other specialists and patients. Like NCQA’s Patient-Centered Medical Home (PCMH) program, PCSP recognition has specific expectations for providing timely access to care and continuous quality improvement. Practices who earn recognition have made a commitment to providing high quality patient-centered care.
Q: What are the requirements for specialty practices?
A: The PCSP recognition standards are:
- Track and Coordinate Referrals: The specialty practice collaborates effectively with other specialists and with primary care practitioners (PCP) to coordinate testing and care of shared patients. Referral communications support the needs of all clinicians.
- Provide Access and Communication: The specialty practice offers timely access to appointments; offers timely responses to telephone and secure electronic messages during and after office hours; addresses patients’ cultural and language needs; and explains the roles of PCPs, specialists and the patients in the collaborative relationship. A specialty practice team trains team members to be patient centered and to contribute to the full extent of their license or role.
- Identify and Coordinate Patient Populations: The specialty practice captures key clinical and administrative data to facilitate reporting on specific populations, uses evidence-based tools to manage care for those populations and follows up when care is needed.
- Plan and Manage Care: The specialty practice develops a patient-centered care plan on its own or in collaboration with a PCP or other specialists, and assesses barriers and progress. The practice manages patients’ medications and provides educational resources or refers patients to community services, as needed.
- Track and Coordinate Care: The specialty practice coordinates use of lab, imaging and other specialty referrals with PCP practices or other specialists caring for a patient, and tracks them from the point of request through receipt and patient notification. The practice also tracks patients as they move through transitions of care, such as hospitalizations.
- Measure and Improve Performance: The specialty practice measures a number of clinical processes or outcomes and patient experience, showing improvement over time, and demonstrates transparency by sharing data within the practice and with external organizations.
Q: Who is eligible for PCSP recognition?
A: All types of medical specialties or subspecialties are eligible, including those that see patients infrequently, those that see patients for a short episode of care and those that provide care for chronic diseases or extended illnesses. Eligible clinicians who typically receive referrals from PCPs and other nonprimary care specialists, and can demonstrate a capability to meet the standards, are eligible, including nonprimary care specialty doctors of medicine, doctors of osteopathy, nurse practitioners, physician assistants, certified nurse midwives and the following behavioral healthcare practitioners:
- Doctoral or master’s-level psychologists who are state certified or licensed.
- Doctoral or master’s-level clinical social workers who are state certified or licensed
- Doctoral or master’s-level marriage and family counselors who are state certified, registered or licensed by the state to practice independently.
Physician assistants, certified nurse midwives and nurse practitioners are eligible to be listed on NCQA’s Web site as providers if they have a panel of patients.
Note: Clinicians who do not have their own panel of patients are not eligible for recognition.
Q: How do we verify our practice’s eligibility for PCSP recognition?
A: All practices are strongly encouraged to verify eligibility before beginning the application process!
The best way to determine eligibility is to attend a free PCSP Standards & Guidelines training session, which is a live, monthly Webinar. All medical specialties (with the exception of primary care specialties where clinicians provide whole-person, patient-centered primary care for ≥75 percent or more of their patients) are included in PCSP recognition.
The “Policies and Procedures” section of the free electronic publication (ePub) outlines eligibility requirements, types of surveys and an overview of the survey process. The ePub also includes the PCSP standards and guidelines.
An eligibility call is necessary for multiple specialties or multiple sites, but is not necessary for all surveys. The application is available online for download, free of charge.
Q: May our practice choose which clinicians to include?
A: No. Practices must include all eligible clinicians. Practices that seek recognition for a defined set of specialties must include every specialist practicing in the defined specialties.
Multi-site practices are eligible, but NCQA requires an eligibility screening call with NCQA staff before completing an application.
Q: I practice both as a primary care and a specialty physician. How do I determine which recognition program—PCMH or PCSP—is appropriate for my practice?
A: First, attend one of NCQA’s free online training sessions; these are live, monthly Webinars that include ample time for clarifying questions.
Both practice-based recognition programs require an eligibility call before an application is submitted for multi-site or multi-specialty determinations. NCQA Recognition program staff work with practices to determine the survey’s structure. The eligibility call will give your practice specific expectations about documentation requirements for demonstrating how clinicians meet the elements.
Q: Is there a document that shows what standards are the same as PCMH standards for multi-sites, at the corporate level?
A: Yes. The PCSP-PCMH crosswalk, which contains this information, and the corporate elements list are both available on the “Resources” page of the application.
Q: Does the PCSP program replace PPC recognition?
A: Yes. If you are eligible for PPC recognition, consider applying for PCSP recognition instead. PPC is being retired on the following timeline:
- Last day to purchase a PPC Survey Tool: March 31, 2013.
- Last day to submit a PPC Survey Tool: September 30, 2013.
Q: Are the PCSP standards related to the CMS Meaningful Use standards?
A: The PCSP program seeks to align with Meaningful Use criteria for Stage 1 and Stage 2. Criteria for both stages are listed in the standards and guidelines, but Stage 2 data collection will not begin until October 2014, with January 1, 2015, as the first date when data may be submitted to CMS. Stage 1 criteria will be used to evaluate the practice until that date.
The standards and guidelines also state when practices are expected to transition to Stage 2 requirements. If percentages will change from Stage 1 to Stage 2, both numbers are included and the Stage 1 number is listed first, followed by “/,” then the Stage 2 number is listed.
For example: “More than 50/80 percent” means that “50 percent” is Stage 1 and “80 percent” is Stage 2 (i.e., reported after January 1, 2015).
The standards and guidelines identify factors as either Core or Menu Meaningful Use requirements and are designated (with plus signs; e.g., +Core Stage 1 and/or Stage 2, ++Menu Stage 1, +++Menu Stage 2).
Q: Is Meaningful Use required for recognition?
A: No. To the extent possible, PCSP standards align with CMS Meaningful Use requirements.
Appendix 2 of the publication (March 25, 2013) is a crosswalk between PCSP standards and Meaningful Use Stages 1 and 2.
Although NCQA encourages practices to pursue achievement of Meaningful Use requirements, and acknowledges the significance of this accomplishment, it is not required for PCSP recognition. Practice settings that cannot meet the Meaningful Use criteria may successfully achieve all levels of PCSP recognition.
Q: Is there a streamlined documentation process for specialty providers who are on the same EMR and in the same medical group as primary care providers who are PCMH recognized?
A: Refer to the PCMH-PCSP crosswalk on the “Resources” page of the application. You may repurpose documentation, but it may be no more than 12 months old.
Q: How did NCQA develop the PCSP program?
A: Development of the PCSP program followed the NCQA product development process and included use of a multi-stakeholder advisory committee, a literature review, public comment, targeted interviews with practices and beta-testing. NCQA drew from the work of the Agency for Healthcare Research and Quality and the American College of Physicians. PCSP standards were approval by the NCQA Board of Directors in December 2012.
Q: Will there be an NCQA Distinction in Patient Experience Reporting component to the PCSP program, as there is with the PCMH survey?
A: No. There is currently no distinction component to the PCSP program because there is no PCSP-specific CAHPS module.
Q: Our organization earned NCQA Certification as a CAHPS PCMH Survey Vendor in 2012. Will there be a separate process to become an approved vendor for PCSP?
A: No. At this time, NCQA does not certify vendors who field patient experience surveys used to meet criteria in PCSP.