CCA-NAMSS (Credentialing Consensus Alliance)

1
CCA-NAMSS(Credentialing Consensus Alliance)

• Facilitator Cris Mobley (NCF rep to CCA)
• Panel members
• Annette Van Veen Gippe-AOA
• Rob Nelson - ABMS
• Betsy Ranslow HRSA, Pract. Data Banks
• Dick Galica - CAQH

2
NAMSS Vision

• To establish the simplest set of consistent
  requirements for credentialing that meets the
  needs of the community
• Discussion on this statement with tendency to
  wordsmith but in the end, not changed
• Agreed that variations /or redundancy increase
  costs
• Discussion began with
• Commitment to single pathway of credentialing
  elements
• What else can we do
• Can common ground be found

3
Organizations Represented

• NAMSS
• National Quality Forum (absent)
• NCQA
• JCAHO
• FSMB
• URAC
• NCF
• AMA-OMSS
• AMA Credentialing products
• AOA
• CAQH
• AHA (absent both meetings)
• ACGME
• CMS
• Practitioner Data Banks
• ABMS
• ABIM
• CVO rep

4
Summary of Expectations

• Define high bar
• Is operationalization possible
• Trust-share data
• Guiding principles
• Collaboration
• Unnecessary duplication
• Best practice
• Implementation
• Reduce redundancy
• Win Win for all organizations
• Turf issues

5
Organizations Weigh In

• CAQH updating application (3/31) using NAMSS
  and NCF core data elements
• Problems with each state with mandated forms
• MGMA estimates cred costs 1.85 billion
• New Hampshirelicensure/hosps apps uniform
• Central data set others can access
• Practitioners enter once

6
Organizations Weigh In

• JCAHO
• Task force on credentialing and privileging
• competency focus
• What info necessary to make decisions for new
  procedures, new privileges, ability to treat
• s and procedures a possibility??
• Value in static information (to be centralized)
• July 05 PSV for all with license,
  certification
• Sidebar
• Capitalize on technology to decrease cost
• Avoid dup of PSV but reluctance to accept that
  which has been verified
• Focus on common data set vs. base
• Long term single source (now theres pushback)

7
Organizations Weigh In

• NCQA
• No changes in credentialing standards
• Dont address privileging
• Stds more structural (than JCAHO)
• There are requirements for recred and ongoing
  monitoring (sanctions, etc)
• Where NCQA has delegation Stds with MCO
  oversight, JCAHO has principles for use of CVOs

8
Organizations Weigh In

• URAC
• 80 CVOs nationally top ones accredited
• PPOs have the most presence for their
  credentialing stds
• Health plan, network cred stds changing see web
  site for public information (field review) e.g.,
  medical director vs. cmte approval will change
  this quarter

9
Organizations Weigh In

• CMS
• Rep sits on PTAC and CMS on JCAHO Bd
• Require periodic appraisals (std practice every
  two years but not in regulation) encouraged
  to discuss 3 yr recred with JCAHO task force
• Must maintain individual files
• Must maintain credentials on license, training,
  experience
• Bylaws describe qualifications to be candidate
  for membership and criteria for determining
  privileges
• CMS only sites against regulations
  interpretative guidelines not enforceable
• Cannot endorse forms, g-lines from other orgs but
  can say its a good idea
• Great if theres a national data element bank
  well play but cant endorse

10
Organizations Weigh In

• CMS continued
• Relies on JCAHO to revise stds
• Minimum stds to get funding they are not setting
  the high bar
• They issue memos of clarification on
  interpretation but regs dont change
• e.g., go to CMS if dont like surveyor
  interpretation they frequently give benefit of
  doubt to org if theyre doing a good job
• Clarified hard copy of license not required
• Check Fedl Register March 25

11
Organizations Weigh In

• NPDB
• Still 2 yr query may change looking into
  proactive disclosure
• Betsy to discuss NPDB news later (good stuff)

12
General Discussion

• We all
• OBTAIN
• VERIFY
• Some ASSESS
• Some REVIEW
• What do we have in common thats workable??? No
  advantage to doing differently

13
General Discussion

• Baby Steps
• Place to go to get the information (raw data)
• Later decide how to verify (now an
  organization-specific process), turf issues
• Some baseline agreement
• JCAHO, NCQA acknowledge 5 equivalent sources
  AMA, AOA, FSMB, ABMS,
• plus NPDB

14
Concepts for Discussion

• Focus on obtaining, verifying, assessing data
• Focus on obtaining and verifying data but not
  assessing data (qualitative)
• Process of review for approval (red flag guidance
  ensuring completeness and accuracy)
• Future identify best practice for verification
  of information

15
Next Steps

• NAMSS to consider doing white paper on needs of
  organizations re the credentialing core data
  elements to include on application
• All should get comments on list of elements put
  tog. by CAQH using their current form, input from
  NAMSS, NCF, and CCA input at meeting (and
  afterwards)
• NAMSS needs to be pro-active vs reactive in the
  industry i.e., electronic app vs paper take us
  into next generation
• Suspend CCA, not disband (innovation could be
  future theme of group)

16
Next Steps

• NAMSS should define other areas to be explored
  and come back as a whole or as subsets to
  discuss e.g., reduce redundancy (or someone else
  will)
• Litigation based on negligent credentialing
  someone should do white paper on this
• CAQH thanked for all work done on collecting and
  integrating info over last 6 months (some
  believed they have the set up to be a central
  source of data repository).

17
Panel comments

• Annette
• Dick
• Betsy
• Rob
• Open Discussion