Olsten to create 'Good Housekeeping Seal of Approval' for home care quality
Olsten to create Good Housekeeping Seal of Approval’ for home care quality
Credentialing standards may affect you even if you don’t work with Olsten
Home care companies of the new millennium, this is your future: You’ve mastered the Joint Commission’s outcomes-based performance improvement standards, but you’re struggling with payers’ credentialing requirements. The payers, many of whom worship the National Committee on Quality Assurance (NCQA) standards and accreditation as king quality, will ask you to meet the standards they have to meet. (See Homecare Quality Management, January 1997, p. 1, for more information on payer demands.)
Future NCQA standards for home care credentialing may be derived in part from the credentialing standards currently being created by Olsten Health Service Network’s new national credentialing committee, say Olsten executives.
"Because there currently are no standards of this type out there in the industry, we look at this as an opportunity to be on the cutting edge," says Paul Leonardo, director of provider relations for Olsten Health Services Network, based in Melville, NY. "This is the first committee of its type in the industry to develop standards of the type that will eventually be adopted by organizations such as the Joint Commission and NCQA."
Paul Schuyve, MD, senior vice president of the Joint Commission, says, "If they are talking about creating standards for what type of qualifications individual practitioners within home care should have, the Joint Commission would clearly be interested in that type of information."
"There are very few standards related to credentialing [of home care providers]," says Marlene Burchell, LPN, CPHQ, credentialing manager for the network. "We hope to help create standards that will be applied to the industry as a whole. We basically volunteered to share the information with NCQA as they develop their own standards."
NCQA is an independent, Washington, DC-based not-for-profit organization dedicated to assessing and reporting the quality of managed care plans, including HMOs.
While NCQA standards have always required health plans to have standards for credentialing all providers they contract with, 1997 NCQA standards only dictate specific credentialing criteria for medical doctors, podiatrists, dentists, osteopaths, and chiropractors, says Barry Scholl, spokesman for the NCQA.
"It’s not impossible that we would expand to include other types of providers, but we are not currently working on home care standards for credentialing," Scholl says.
However, when Cigna HealthCare’s credentialing oversight committee randomly audited 11% of Olsten’s credentialing files, they found a compliance rate of 97%. Other home care companies may be wise to follow the network giant’s lead.
Credentialing accounts for about 25% of the NCQA accreditation score, according to Burchell. "So you can see it’s very important to payers," she says. Both MCOs and the NCQA "will start to look at home health care credentialing more stringently," Burchell predicts.
Olsten’s credentialing committee comprises members from different parts of the country and various health care specialties. The committee now has 20 members. Ten of the 13 members external to Olsten are physicians, and several also are medical directors. "We made it so we would have representation from all across the country in every specialty that we could possibly want," Burchell says.
"The elements of the program will cover a lot of ground," says Steven Peskin, MD, medical director for the network. "We’re going to work toward specific credentialing for [specialties such as] infusion, nursing, medical equipment, pediatrics, and physical, occupational, and speech therapies. But there will be a general section of credentialing." (See general credentialing criteria in related story, p. 102.)
Olsten Health Services now requires that all its providers nationwide, home health and otherwise, go through the same credentialing process. Providers in the Olsten Health Services Network used to be credentialed on the state level. Olsten Health Services, a subsidiary of Olsten Corp., operates about 600 health care offices in the United States and Canada. In 1996, the company provided services to more than 400,000 client/ patient accounts.
"In their contractual relationship with us, [payers] expect us to adhere to the same standards they are asked to adhere to from those accrediting bodies from a credentialing standpoint," says Leonardo. "And they expect us to put our network providers that have signed up to provide service to their patients and members through a rigorous application and quality check process whereby we review not only their ability to service from a quality perspective, but whether they meet certain standards set forth by NCQA, the Joint Commission, and the standards we now are seeking to develop through our national credentialing committee."
Olsten plans to create the policies and procedures for how home care providers are credentialed to help health plans meet their accreditation obligations in the market place. "We, too, will be able to give a Good Housekeeping Seal of Approval’ to those providers [who can meet the criteria]," says Leonardo.
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