Nat'l Cred Forum - Feb. 12, 2005 1 CCA-NAMSS (Credentialing Consensus Alliance) Facilitator: Cris Mobley (NCF rep to CCA) Panel members: – Annette Van

Nat'l Cred Forum - Feb. 12, 20051

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


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


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


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


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 Hampshire–licensure/hosps apps uniform– Central data set others can access– Practitioners enter once



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 there’s pushback)



NCQA– No changes in credentialing standards– Don’t 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



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



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 it’s a

good idea– Great if there’s a national data element bank; “we’ll play but can’t

endorse”



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

don’t change e.g., go to CMS if don’t like surveyor interpretation; they

frequently give benefit of doubt to org if they’re doing a good job

– Clarified hard copy of license not required– Check Fed’l Register March 25



NPDB– Still 2 yr query – may change; looking into

proactive disclosure – Betsy to discuss NPDB news later (good stuff)


General Discussion

We all:– OBTAIN– VERIFY– Some ASSESS– Some REVIEW

What do we have in common that’s workable??? No advantage to doing differently


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


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


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)


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).


Panel comments

Annette Dick Betsy Rob Open Discussion

Documents

Nat'l Cred Forum - Feb. 12, 2005 1 CCA-NAMSS (Credentialing Consensus Alliance) Facilitator: Cris Mobley (NCF rep to CCA) Panel members: – Annette Van