How to identify high cost specialists and how to create a care coordination agreement

July 28, 2017

Written by Kristen Schuster, Practice Facilitator

The utilization reports are broken down in to several categories for your practice to reference. One of the areas is identifying high cost specialists. Your practice can use this information to create collaboration agreements.

What applies to the specialist in a care coordination agreement?

Specialist agrees to refer patient back to primary care physician (PCP) if additional diagnosis arise
Secondary referrals are communicated back to the PCP
Notify PCP of no-shows and cancellations
If a patient self-refers the specialist agrees to notify the PCP
Identify a timeline to receive specialist reports

What applies to the PCP in a care coordination agreement?

PCP will prepare patient for the reason of the referral
Provide adequate and timely medical records to the specialist
Indicate urgency of the referral
Provide direct contact information for the referring provider
Follow-up with patients that no-show or cancel

CPC+ does expect care coordination with a specialist. The utilization report makes it easy to identify the specialist providers that are seeing your patients the most. Aligning the care coordination agreements with the utilization reports will aid in reducing patient costs to the health care system. Please refer to CPC+ for examples of a care coordination agreement.

If you have any questions, or run into issues with any of the CPC+ objectives and would like help please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.

Other Resource Links
Catch up on the national learning webinars with Mountain-Pacific Quality Health’s quick FAQ sheet.
Recorded CMS Feedback Report Webinar
CMS Change Package
See all CPC+ Blog Posts

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