Additional specialty types to become eligible for fee uplifts

As part of the continuing development of the Physician Group Incentive Program and Organized Systems of Care, 17 additional specialty types will be eligible for fee uplifts, effective Feb. 1, 2014. This brings the number of eligible specialty types to 24.

The specialist fee uplifts are designed to reward specialists for partnering with a community of caregivers as patient-centered medical home “neighbors” to provide high quality, cost-effective care for a shared population of patients. The patient-centered medical home neighbor, or PCMH-N, concept introduced by the American College of Physicians outlines principles to promote improved coordination between PCMH and specialty practices.

Below is a complete list of the eligible specialty types:

Only specialists who are PGIP members and who participate through a PGIP physician organization as of Aug. 1, 2013, are eligible for the 2014 fee uplifts. The specialist practice units must be nominated by their member PO and, in some cases, another physician organization with which the practice shares a substantial number of patients. Nominated specialists are evaluated for the fee uplifts based on quality, cost, utilization and efficiency measures at a population level.

Eligibility for the specialist fee uplifts is determined on an annual basis. We encourage each practitioner who is not yet a member of PGIP to:

• Reach out to a physician organization he or she feels best represents their natural community of caregivers.
• Discuss PGIP with his or her provider consultant and begin a conversation about fee uplift eligibility for 2015.

Members of PGIP with questions about the fee uplifts should consult with their POs.