NCQA's CVO certification under fire from AMA
NCQA’s CVO certification under fire from AMA
Exclusionary and monopolistic conduct?
The American Medical Association in Chicago has criticized the National Committee for Quality Assurance (NCQA) in Washington, DC, regarding its process for certifying credentials verification organizations (CVOs). The association termed the certification process "defective" and issued a resolution for new tests to be devised.
CVOs verify doctors’ credentials for managed care organizations, hospitals, and other integrated delivery systems. The organizations that entrust CVOs with that task are required to oversee their work. NCQA established a certification program to expedite that oversight process. In essence, CVOs that are NCQA-certified have a type of deemed status, and health care organizations’ oversight responsibilities are greatly reduced by contracting with them.
The Medical Society Credentials Verification Organizations of America (MSCVOA) represents more than 350,000 physicians in 38 states. The group grew out of a special interest group of the American Association of Medical Society Executives. The MSCVOA seeks to meet the credentialing standards of the Joint Commission and the National Committee for Quality Assurance (NCQA).
A poor showing
The NCQA found 11 of the more than 35 CVOs surveyed for accreditation this past summer lacking, and denied them full certification. Three were denied certification altogether. Eight received certification for a limited number of elements. All 11 were operated by state and county medical societies.
In reviewing the past summer’s events, AMA delegates determined that the NCQA accreditation process must be faulty, and the CVOs are not necessarily at fault. It was determined that the certification standards must be ambiguous, and that surveyors do not adhere to them properly. The delegates also criticized the NCQA for providing inadequate information about the nature of the defects they found. Some say inadequate information was provided before the reviews started.
NCQA officials say the CVO certification standards were piloted and well-tested. Nine months before the review, they say, they made the draft standards available to the CVOs.
"The CVO certification program is a voluntary one," notes NCQA spokesman Barry Scholl. "The NCQA has no regulatory muscle. Organizations are encouraged to undergo the certification process because in the long run it helps eliminate redundant oversight and makes the credentialing process more efficient."
Not a rubber stamp
"The AMA’s complaint that there may have been some inherent bias is unfounded," he continues. "The program is rigorous and was never meant to be a rubber-stamp process. The certification standards are exactly the same for medical society CVOs as for other entities running the program. The medical society CVOs have just as much potential to succeed in the certification program as other CVOs, and we’re very interested in working with them to ensure that they do."
Some are seeking alternatives to the NCQA seal of approval for CVOs. Meanwhile, the AMA delegates have called for a review of what they characterize as "exclusionary and monopolistic conduct" of the NCQA. That review will determine if a complaint to the Federal Trade Commission is warranted.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.