First in Oregon: Specialty Practices Earn NCQA Recognition
The Portland InterHospital Physicians Association (Portland IPA), http://www.portlandipa.com/, Oregon’s largest physician group comprising more than 2,800 primary care and specialty physicians, announced that three clinics − the first in Oregon − have been officially recognized by NCQA (National Commission on Quality Assurance) in its new recognition program for specialists who work with primary care medical home practices.
NCQA and the Portland IPA have partnered on the Patient-Centered Specialty Practice Recognition program, http://www.ncqa.org/Programs/Recognition/PatientCenteredSpecialtyPracticeRecognition.aspx. The specialty component complements the Patient-Centered Medical Home primary care program the Portland IPA launched in 2010, also in partnership with NCQA. The Portland IPA was also the first organization to launch the NCQA’s medical home program in Oregon.
“This new recognition program connects specialty and primary care physicians in the medical neighborhood,” said Tom Gragnola, M.D., primary care physician with Greenfield Health and medical director of the Portland IPA. “Currently, there are few, if any, financial incentives to coordinate care. Advances in IT haven’t completely solved the problem. So we ask, ‘How do we regain the connectedness that provides our patients the best care?’”
Dr. Gragnola adds that the overall goals comprise a concerted effort to improve patient outcomes; enhance patient safety, increase patient satisfaction, reduce redundancy of services, improve efficiency of care and create greater communication and collaboration. He points to the need for this program among specialty practices to help them successfully engage with Coordinated Care Organizations and emerging models such as ACOs (Accountable Care Organizations).
In a program similar to the primary care medical home, the NCQA Patient-Centered Specialty Practice Recognition program shows that specialists are more qualified partners in the care continuum in six standards, http://www.ncqa.org/PublicationsProducts/RecognitionProducts/PCSPProducts.aspx:
Tracking and coordinating referrals
Providing access and communications
Identifying and coordinating patient populations
Planning and managing care
Tracking and coordinating care
Measuring and improving performance.
The three clinics that have achieved Specialty Program Recognition include Women’s Healthcare Associates Peterkort South (http://www.whallc.com/), Providence Heart Clinic at The Oregon Clinic Gateway (http://oregon.providence.org/patients/programs/providence-heart-clinic-at-the-oregon-clinic-gateway/pages/default.aspx), and The Liver Clinic at The Oregon Clinic Gastroenterology - East
(http://www.oregonclinic.com/specialties/hepatology-liver-disease). EyeHealth Northwest (http://www.ehnpc.com/) is awaiting final NCQA confirmation of recognition. Compass Oncology (http://www.compassoncology.com/) has recently received approval of their corporate survey and is working on their submission as a multi-site practice.
“For a person who needs to see a specialist, the right clinician can make the difference between living with their chronic health concern as opposed to suffering from it,” said Margaret E. O’Kane, president, National Committee for Quality Assurance. “By earning recognition, these practices have demonstrated that they provide effective, evidence-based care to their patients with specialty care needs.”
"By helping specialists and their practices improve clinical efficiency and clinical management functions, they have demonstrated they are focusing on integrating and coordinating care," said Portland IPA (http://www.portlandipa.com/) Executive Director Donna McClellan, R.N. She adds that the benefits for specialists who have completed the new specialty program recognition include global budgeting and payment bundling, and visibility that the practices are ready for delivery/reimbursement models that focus on outcomes measurement.
The Portland IPA launched the new program with five specialty practices to demonstrate how this new model integrates specialists in the medical home philosophy. In this model, specialists can increase practice efficiency, integrate care via improved care coordination, create enhanced referral pathways, and work toward providing more efficient, quality medical care at the top of their practice.
Says Xiaoyan Huang, M.D., FACC, cardiologist with the Providence Heart Clinic at The Oregon Clinic, “We are very excited to be part of the IPA pilot project to achieve NCQA specialty practice recognition. We wanted to learn from managed care-era lessons where primary care physicians were asked to be gatekeepers, and specialists were relegated to the periphery of the medical neighborhood. The NCQA standards for specialty practice allows specialists to not only connect better with primary care providers, but also laterally with other specialists. Gaining NCQA is not an end but only a means for us to continuously improve our practice quality and patient safety. It is what we have always done, but need to do much better.”
“We recognized the NCQA specialty certification process as a really well-structured approach to creating systems that improve care coordination among primary and specialty providers,” said Women’s Healthcare Associates President Damon Warhus, M.D., “The systems help us see referred patients more quickly and assure the right communication is happening between providers at the right time, giving all members of a patient’s medical team the information they need to make clinical decisions with the patient at the center, regardless of which medical group they are a part of.”
Ken Flora, M.D., FACG, AGAF, director of Hepatology for The Liver Clinic at The Oregon Clinic Gastroenterology - East, noted the process that his practice went through to earn specialty recognition. “NCQA recognition required that we rigorously review of patient protocols in a meaningful way, paying particular attention to developing means of communication between ourselves, the patients and the primary providers.” He added, “We developed pathways defining levels of care among the different liver diseases allowing us to determine who would do what, when, where and for how long. We configured our clinic into a ‘medical neighbor’ that would interact with primary care providers in a manner that would better satisfy the expectations of them and their patients. We developed clinical algorithms and distributed them to primary medical homes to standardize the evaluation of patients with liver disease and to do better define at which point referrals to specialists would be appropriate.”
NCQA is a private, non-profit organization dedicated to improving health care quality, that accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. NCQA is committed to providing health care quality information through the Web and the
media in order to help consumers, employers and others make more informed health care
choices. Consumers can easily access organizations’ NCQA Accreditation, Certification and
Recognition statuses and other information on health care quality on NCQA’s Web site at
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About The Portland InterHospital Physicians Association
The Portland InterHospital Physicians Association (Portland IPA), is a for-profit corporation, incorporated in the State of Oregon. Portland IPA has been in existence since 1983, and is one of the largest and oldest independent practice associations in the United States. The Portland IPA contracts on behalf of more than 2,800 northern Oregon members, including primary care doctors, specialists and allied providers. The Portland IPA provides member services and assistance that improves members’ clinical and economic performance.