Doctors move to control credentialing process
AMAP: A massive undertaking
Under the American Medical Association’s American Medical Accreditation Program (AMAP), physicians will receive constructive feedback from colleagues who understand the complexities of medical practice. First proposed in June 1996, the landmark plan was approved by the AMA House of Delegates on Dec. 10, but will not be fully implemented for four years.
The resolution came in reaction to testimony indicating that commercial vendors and HMO groups are beginning to develop their own verification programs as they build provider panels and develop physician profiles. The AMA claims those efforts often proceed with little physician input, despite the fact that physicians actively involved in clinical practice are best suited to determine the appropriateness of that clinical practice. In that regard, the AMA says AMAP represents an improvement over the current procedures because physicians themselves will set the criteria and procedures for credentialing and office site review.
The AMA intends to become the across-the-board office accreditor for all physicians affiliated with managed care plans. The association will market the plan to 600 health plans and 5,000 short-stay hospitals as a replacement for existing credentialing systems. The initiative aims to establish a standard of physician excellence that will be accepted universally by hospitals, insurers, and other health care organizations, including the Joint Commission.
AMAP will assess physicians’ performance in five areas:
• credentials verification of education, training, licensing, CME, and work history;
• personal qualifications, such as ethical behavior and involvement in peer review and self-assessment;
• environment of care, including office site reviews, clinical operations, and management systems;
• clinical performance as measured against national benchmarks appropriateness of services, compliance with guidelines for preventive care, early disease detection;
• patient care results, encompassing clinical outcomes, costs, and patient satisfaction.
In five years, with a projected $50 million budget, AMAP plans on looking at the latter two components clinical performance and patient care results.
The project will be piloted on a state-by-state basis. Criteria have been established for the first three components, and pilot testing started in early March in Massachusetts facilities. That state was chosen as a first pilot site because the medical society there had the necessary accreditation infrastructure in place. Future sites will be chosen according to how far along the state societies are in providing compatible accreditation services. New Jersey is next. As more states are added, problems will be uncovered, defined, and addressed.
AMAP’s governing board is composed of experts representing state, county, and specialty societies as well as hospitals, consumers, managed care organizations, and employers. The board includes four at-large physician seats to ensure adequate physician input.
One of the goals of the plan is to help patients make informed decisions about their physicians. It is intended to assure health care consumers that a physician has met the highest standards set by the medical profession. This should strengthen the physician-patient relationship with less interference from outside groups. A second goal is to ease administrative burdens of hospitals and plans by streamlining the current complex, duplicative, and sometimes conflicting credentialing process.
If it ain’t broke . . .’
Many state, county, and specialty medical societies play a vital role in credentialing and office site reviews. AMAP is structured in a way that retains some of those current credentialing procedures and extends them to a national level. A mandate of the AMA’s resolution pertaining to AMAP states that the association employ the federation concept and network with state and county medical societies’ existing credential verification services and centralized site/chart review programs in the implementation of AMAP. Physician-directed services that meet or exceed AMA standards will remain in operation.
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