AMA’s accrediting program up and running in 7 states
National process avoids duplicative credentialing
Physicians from Connecticut, Hawaii, Idaho, Massachusetts, Montana, New Jersey, and the District of Columbia have applied for accreditation by the American Medical Accredita tion Program (AMAP), the program created by the American Medical Association (AMA) in Chicago. The new voluntary accreditation program measures and evaluates individual physicians against national standards, specific criteria, and peer performance. Meeting and maintaining AMAP’s standards earns a physician the program’s accreditation. Basically, it puts hospitals and the physicians they credential on the same page.
In operation since early this year, the program covers:
• Credentials: Primary source-verified information.
• Personal qualifications: Ethical behavior and documented participation in continuing medical education, peer reviews, and self-assessments. Fraud and abuse issues also will be included.
• Environment of care: Practice site review of office operations and medical records.
• Clinical process: Standardized measures of key patient care processes and comparative feedback to physicians on their performance.
If physicians have gone through a performance measurement system, they receive points for doing so in the same way they receive points for accumulating CME or going through a peer review program. In late spring, AMAP issued draft criteria for AMAP-compatible physician performance measurement systems. There was a one-month comment period on the criteria. Once implemented (which is projected to occur within a year or two), the criteria will identify AMAP-compatible per formance measures from which physicians can choose and voluntarily participate in.
"AMAP’s overall thrust is to improve the quality of medical care," says AMA spokesman Robert J. Mills. "In keeping with that, parts of the program deal with patient outcomes and satisfaction. That’s where the criteria for AMAP-compatible physician performance measurement systems come in." AMAP is not creating a performance measurement system. Rather, it is accumulating lists of systems already in use and presents them to physicians with the understanding that they can voluntarily participate in those systems that gain AMAP approval and earn supplemental points toward their AMAP accreditation.
AMAP emphasizes peer review feedback
"No system will be listed with AMAP unless it contains a peer review feedback loop," he explains. "There are a lot of physician performance measurement systems out there, but most do not feed back to the physician. They don’t provide credible evidence that physicians need to change practice attitudes." The AMAP team wants to influence the construction of any new performance measurement systems to include that feedback loop, and that is why the criteria are important.
AMAP does not now require physicians to go through performance measurement systems because, according to its definition, the state-of-the-art system does not yet exist. "Until some rock-solid criteria are available," says Mills, "AMAP won’t make participation in performance measurement systems mandatory for physicians. We anticipate that in the future it will be mandatory, but not until the available systems are more credible."
Though accreditation has long been available as a quality standard for hospitals, payers, and managed care organizations, no single nationally recognized program has existed for individual physicians. Instead, physicians undergo fragmented and duplicative processes for credentialing and office site reviews, and they are evaluated against multiple, sometimes conflicting, performance criteria. Hospitals make their own decisions on granting privileges based on accreditation information purchased from AMAP.
Hospital Peer Review asked Mills how AMAP and the AMA’s Physician Masterfile interact. "A physician’s AMAP accreditation application is seeded with information from the Masterfile — information having to do with residency, medical school, and so on. But AMAP gathers more information than that on the Masterfile." How will a Joint Commission surveyor view AMAP accreditation? "AMAP meets or exceeds all Joint Commission requirements. All activities are in full compliance with its requirements as well as those of NCQA and other accrediting bodies. The Joint Commission, AMAP, and NCQA cooperate on the Performance Measurement Coordinating Committee." (See article on AMAP-JCAHO-NCQA cooperation, p. 125.)
To become a part of the AMAP system, a physician completes one application. The system verifies credentials information with primary sources and conducts office site reviews, Mills says.
"AMAP checks NPDB [National Practitioner Data Bank] for a physician’s legal violations and licensing problems," he says. "If a physician defrauds Medicare, Health and Human Services reports that to NPDB, and the AMA Masterfile updates its information from there."
AMAP provides a report and certificate to each physician who meets its standards and provides a portfolio of verified credentials and office review information to each health plan, hospital, or other organization that uses the accreditation system. More information about AMAP can be obtained by calling (312) 464-5519.
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