Will AMAP help or hurt your facility?
Will AMAP help or hurt your facility?
AMA’s new accreditation program being piloted now
The American Medical Association’s new credentialing program targeted for launch in 2001 could relieve you of one of your most onerous tasks. But many quality managers are uncertain whether the ambitious program can live up to expectations.
The American Medical Accreditation Program (AMAP) aims to be a single, universally recognized standard of quality for physician accreditation. The plan will create uniform national criteria to assess physician performance and is intended to replace the current duplicative and fragmented patchwork of physician credentialing programs. The plan will not provide specialty board certification. Such certifications will be included in AMAP’s profile, but the program is separate from specialty certification. The program will make one voluntary biennial inspection, resulting in less disruption of offices, medical records, and patient programs, the AMA says.
How far will AMAP go?
Some credentialing staffers are skeptical. Before adopting AMAP, QM staffers say they want to see how the system would operate in its final form. They also want to know how thorough the AMA verifications would be. For example, if AMAP credentialers don’t get a response from a school or institution, will they pursue it?
A director of medical staff and education services at a large Texas hospital says she’s unconvinced that AMAP would help her institution. The hospital doesn’t use the AMA physician profiling now, says the director (who asked not to be identified), so it probably wouldn’t use AMAP. She and other credentialing staffers told Hospital Peer Review that AMA profiling sheets invariably contain "unconfirmed" or even incorrect data that simply create extra work. They say they wouldn’t feel comfortable with AMAP unless it worked better than that.
Physician credentialing has to be thorough and correct, including the investigation of time gaps. Outside credentialing organizations often don’t go far enough, credentialing staffers say, and applications likely will come back to your desk for completion.
As things stand, QM staffers either must rely on outside groups to do their credentialing, or do it themselves. Having one group do this task in one standard way seems a step forward. The AMAP criteria promise to be of the strictest quality. If a physician is accredited by AMAP, that should be undisputed assurance that he or she meets the highest standards of professional quality, says the AMA.
Some see a welcome improvement
Support for the program is gaining momentum as more information about it is disseminated, says an AMA spokeswoman. She says the response to AMAP from the quality assurance field and the managed care community has been enthusiastic for the most part. QA personnel doubtless need a reliable way to identify quality, and some have told the AMA this may be a valuable tool as long as it lives up to expectations.
"AMAP may be a positive move," says Judy Homa-Lowry, RN, director of quality improvement at The Delta Group in Greenville, SC. "For meaningful credentialing, we need to know detailed information about a physician’s performance a profile of his care. If AMAP will in fact have a mechanism measuring outcomes and benchmarks, that would be valuable. (See related story on how the plan will work, p. 31.)
"Many times physician outcomes are influenced by the environment in which the physician practices," continues Homa-Lowry. "An analysis of outcomes has to be done to establish whether the system, not the physician, may be responsible for a poor outcome. It will be interesting to see who determines the benchmarks and what criteria is used in the AMAP. Who’s going to be abstracting the mortality data? Who’s going to be determining whether it’s valid and reliable? Will the AMA be developing its own database? The idea is noble, but a bumpy road may be ahead as this is being developed."
Jean Deecki, RN, coordinates credentialing for Marian Community Hospital in Carbondale, PA. In that capacity, she follows the process through from sending out applications and re-applications, to reviewing applications with the department chief, and preparing for the credentials committee and board. "The concept of a centralized credentialing program makes a lot of sense," says Deecki. "It would help us make quicker decisions regarding the granting of re-appointments."
She complains that the current system is disjointed, leaving her to verify the same facts another hospital is also checking. She has to check the National Practitioner Data Bank and call individual boards to gather information.
"With a centralized credentialing service, we would all get the same information at the same time, and the work would be done only once," Deecki says.
The medical staff of Marian Community Hospital has approximately 160 members; each has to be credentialed every two years. In addition, there can be between one and five new applicants per month.
Even physicians are skeptical
An AMA survey found that while 60% of doctors want such a program, only 9% would entrust it to the AMA. Some nay-sayers said the program puts the fox in charge of the henhouse.
HPR asked Dale Duncan, RN, credentialing administrator at Anderson (SC) Area Medical Center, what she thought of AMAP. "It’s too soon to say," she says. "Credentialing is by its very nature hospital-specific. I can trust the integrity of our process because we do it ourselves. If I were convinced that AMAP would do as thorough a job as we do, I’d consider using the system."
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and the Health Care Financing Administration publish requirements regarding physician credentialing for accreditation and licensing purposes and for liability insurance. They are fairly consistent, but some ambiguities persist, such as the Joint Commission’s requirement that hospitals must use performance data at the time of reappointment. Hospitals are struggling with a definition of the term "performance data." What specific data should be used? Each organization must develop mechanisms for criteria, review, and reporting.
"Credentialing involves measurable performance data," continues Duncan. "The Joint Commission’s standards are not prescriptive, however, so how hospitals go about gathering data is left up to them. At Anderson, we’ve refined that requirement into a process."
A doctor’s provisional period is particularly important, Duncan notes. "We’ve instituted a department-specific proctoring process to collect the necessary quantitative data. The department of surgery, for example, proctors a certain number of procedures and reports to us the adequacy of the pre-, intra-, and postoperative care. At the end of the year, we have quantifiable data on that physician’s performance."
Anderson has 270 physicians on staff. "Credentialing is the cornerstone of quality of care and must be taken very seriously," says Duncan. "If that step is not done well, everything else done in the hospital is simply a stopgap."
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