NCQA 'seal of approval' for physician groups
NCQA seal of approval’ for physician groups
Certification covers quality, utilization
In what could become a managed care "seal of approval" for large group practices, the National Committee for Quality Assurance (NCQA) in Washington, DC, announced a certification program for physician organizations. For medical groups that are weary of the parade of health plan audits, that means they will have the option to streamline the process with a single survey. Certification also could become a marketing chip in the highly competitive managed care arena.
These surveys relate to accreditation standards such as quality improvement, utilization review, and preventive health that health plans may delegate to physician organizations. The program does not involve medical chart review for Health Employer Data and Information Set data collection.
Delegation is common in areas where capitation contracts are predominant, such as California and Minnesota. Yet the certification program is attracting attention from around the country as a way to promote efficiency and reduce the burden of audits, says NCQA spokesman Barry Scholl.
"Physician organizations and health plans alike had been requesting we do something along these lines for quite a while," he says.
Certification is not synonymous with accreditation, as it doesn’t involve an overall assessment of clinical and administrative quality, Scholl says. Other organizations, such as the Medical Quality Commission in Seal Beach, CA, and the American Medical Association in Chicago, offer physician accreditation programs.
NCQA certification will be costly for physician groups. The program is designed primarily for organizations of 50 or more physicians.
NCQA surveys will involve an off-site review of documents and an on-site review by a two- or three-person team of physicians and managed care experts that lasts one to three days. Medical groups can receive certification in one or more of six categories. The cost varies according to the size of the practice, but the range is $18,800 to $23,100 for two categories and $24,200 to $31,800 for six categories.
The categories are: quality management and improvement, utilization management, credentialing and recredentialing, preventive health, members’ rights and responsibilities, and medical records.
NCQA will conduct three pilot surveys this summer and release final standards in the fall. It expects to be able to conduct 25 surveys between October and December, Scholl says. Certification initially will last one year; after a second successful survey, that may be extended to three years.
Certified physician organizations will receive a Letter of Certification they can use to advertise and market themselves to managed care organizations. However, NCQA is developing specific language that physician organizations must follow in their advertisements.
[Editor’s note: For more information on the Physician Organization Certification program, contact the NCQA Customer Service Center, 2000 L St. NW, Suite 500, Washington, DC 20036. Telephone: (202) 955-5697. For a free copy of the program’s draft standards, call the POC Line at (202) 955-3562 or download them from the NCQA Web site: http://www. cqa.org/ftpdocs.htm.]
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