AMA launches new accreditation standard

A new seal of approval

Accreditation and outcomes measurement have historically focused on the performance of health plans, rather than on outcomes data from individual physician practices — at least in the eyes of the public. But a new American Medical Association program will offer practices an opportunity to gain their own accreditation, which could mean a potential marketing advantage with payers and consumers.

Starting this fall, the AMA will offer an accreditation program for individual physicians. The American Medical Accreditation Program (AMAP) is due to accept applications from New Jersey physicians in late September, and in Massachusetts shortly thereafter. AMAP is supposed to be the "gold standard" for quality, according to the AMA.

The association says AMAP will help physicians differentiate among themselves for the benefit of managed care organizations, and thus obtain better contracts. The accreditation also is intended to help managed care organizations determine which physicians are of the highest quality.

"Anything that highlights the services we provide, the ability of our physicians, and the satisfaction level of our patients is good for us," says Jeff Stott, operations manager for Women’s Health Care in West Newbury, MA. That practice acted as a test site for the AMAP program.

In the future, practices that go through the AMAP program will be able to compare themselves to other practices around the country, which could prove another beneficial marketing tool, says William Jessee, MD, the AMA’s vice president for quality and managed care.

He says doctors will welcome the opportunity to be recognized by their peers, and the public will appreciate having a quality gauge for physicians. "When our first certificates come out, we’ll be blitzing the airwaves advising consumers to look for the AMA seal of approval," says Jessee. "Good Housekeeping is exactly the prototype we have in mind."

The AMAP survey is not easy, says Lisa Cane, practice administrator at Women’s Health Care. Two nurse reviewers and two AMAP project managers visited Women’s Health Care and spent more than an hour on chart review alone. Cane says they looked at every page for items such as proper patient identification, provider signatures, and appropriateness of diagnosis and referral.

"They looked at test results to make sure the provider signed off, acknowledging that the results were actually seen," she says. "They looked for an indication that there had been patient education. They were hoping to find problem lists, medication lists, preventive medicine tracking, and allergies indicated both inside and on the front of the chart."

The reviewers also asked for written policies and procedures, such as nurse triage protocols for relaying messages from patients to doctors and guidelines for urgent care vs. emergency care. They asked about scheduling policies and how the practice handled hazardous materials.

Are you spore-testing your autoclaves?

The whole process was a learning experience for Cane, who admits there were some items she could not immediately locate. And at least one procedure changed due to the site review. "They asked us whether or not we did spore testing on our autoclaves to ensure we are really killing any microorganisms," she says. "We didn’t do that, but now we do."

Cane says the AMAP review was more in-depth than those conducted by managed care organizations seeking information on a potential contractee.

Despite the rigors of the AMAP process (for a complete list of requirements, see related story, above), it does have critics. Jerome Kassirer, MD, editor-in-chief of the New England Journal of Medicine, tells Physician’s Managed Care Report the AMA should release the program to an independent board. "You would not want the airline pilots association setting standards for pilots; you’d want the Federal Aviation Administration to do it," he says.

Currently, the AMAP program is run by a governing board that includes people from the AMA board, medical societies, hospitals, insurers, accreditation organizations, and consumers.

In an editorial in the July 6 edition of the Journal, Kassirer said the standards are too low and wondered whether physicians who were not board-certified would seek accreditation as an alternative way to market themselves to the public.1 Joseph Heyman, MD, FACOG, president of Women’s Health Care, argues that the standards are tougher than those imposed by the National Committee for Quality Assurance (NCQA) in Washington, DC. The NCQA accredits health plans.

Heyman says one benefit of AMAP is that it could lead to fewer inquiries and intrusions into a practice. If health plans accept AMAP accreditation and pay to receive the reports, the AMAP physicians would face just one review every two years. AMAP could be a "time-saver, money-saver, and life-saver" for physicians, and he hopes to be among the first to receive the accreditation.


1. Kassirer JP. The new surrogates for board certification — What should the standards be? N Engl J Med 1997; 337:43-44.