AMAP helps improve operations, reward staff
AMAP helps improve operations, reward staff
Accreditation program available in more states
When Randall Smoak Jr., MD, and his office staff went through the American Medical Accreditation Program (AMAP) review, the Orangeburg, SC, surgeon’s office staff already had the reputation of being on top of things.
"Even so, going through the process of AMAP, our office staff learned some things and improved further. The most important thing to me was that when we were assessed, our office staff had a great sense of reward. Not only did they have the reputation of being excellent; the staff knew they were, based on national standards," says Smoak, who is president-elect of the American Medical Association (AMA) and chair of the AMAP governing body.
Smoak’s office was the first in the nation to go through the accreditation process.
"As chair of the AMAP governing body, I felt like I should go through the process and know what it was like before suggesting that other physicians go through it," he says.
The AMA introduced its voluntary accreditation program in 1997.
New Jersey was the first state to implement AMAP. So far, medical societies in nine states and the District of Columbia have entered into an arrangement with the AMA to offer AMAP, with more expected to come on board soon.
The organization’s goal is for AMAP to be available in all 50 states by 2005.
"It’s an opportunity to let patients know that their physician meets some national standards that would indicate that the physician and his office are operating at a very high level," Smoak says.
AMAP is a voluntary accreditation program that measures and evaluates individual physicians against national standards, criteria, and peer performance in the areas of credentials, qualifications, and environment of care. Eventually, the standards will be expanded to include clinical process and patient outcomes.
Combining assessments
AMAP officials are trying to persuade health plans and hospitals to use AMAP for their physician credentialing and evaluation.
Physicians, on average, belong to 10 health plans. This means 10 similar forms to be filled out and 10 different site visits every few years.
"The concept is to combine all that into one and carry out a more extensive, detailed assessment of the environment of care as well as an assessment of the physicians," Smoak says.
Most physicians who are not awarded AMAP accreditation fail because they do not pass the environment of care section, an on-site review of office procedures and policies, says William Jessee, MD. He is chief executive officer of the Medical Group Management Association (MGMA) and led the development and implementation of AMAP as the AMA’s vice president for quality and managed care.
Some key areas where offices often need improvement include:
• Written office policies and procedures.
"Many times, we take for granted that the staff knows what to do in certain situations," Smoak says. For instance, physicians don’t always know the level of triage that takes place because the nurse handles it. But in some cases, the nurse may be going beyond what the physician thinks is appropriate, rather than calling in the doctor, he adds.
"If you have to go through the mechanics of addressing such things as how you handle after-hours telephone calls, it points out the instances in which clearer directions are needed. Going through this exercise is helpful to more clearly define how everyone’s roles should function," he says.
• The ability to respond to an emergency.
If an emergency occurs, a practice should have trained personnel to respond to it. For instance, Smoak tells of a situation in which a patient’s spouse had a heart attack while the patient was being treated in an ophthalmologist’s office. The physician and a nurse, who was certified in CPR, responded, called the paramedics, and got the spouse to the hospital in time to save the spouse’s life.
"That’s the kind of thing we never expect to occur in some offices. If it happens on a street corner, we’d say that was just that person’s luck. In a physician’s office, we’d expect some level of emergency care to be given appropriately to save the patient’s life," he says.
• Safety measures.
"Physicians need to make sure that the office is not only an inviting place but a safe place. The whole issue of patient safety is of more concern as more and more services that used to be done in the hospital are being done in the office," Jessee says.
Before anyone goes through the accreditation process, they know exactly what criteria will be used. The AMA has the standards on its Web site (www.ama-assn.org) and they are available in booklet form, along with helpful suggestions on how to improve in the areas that will be judged.
Generating self-imposed improvement
"This is important, because we’re not trying to generate a punitive situation. We are trying to generate a self-imposed physician improvement," Smoak says.
A highly trained nurse who has experience in judging the quality of the indicators conducts the office visits. The conclusions are reviewed by a physician panel.
For instance, if the practice has a written escape plan in case of fire or calamity, and the nurse sees that it’s in place, that’s all that’s necessary. If the nurse has some questions about the charts, the physician panel reviews them.
The people conducting the office visits have years of experience in judging criteria from other accrediting organizations, such as the Joint Com mission on Accreditation of Healthcare Organiza tions, Smoak says.
The office site review takes between two and three hours, depending on how many physicians are in the office.
"We are sensitive to the things that physicians fall down on during site visits, and we will re-examine them periodically to see if they are too stringent," Smoak says.
Practices that do not pass the accreditation criteria have an opportunity to make an appeal and reapply.
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