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 Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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 Hampshire–licensure/hosps apps uniform • Central data set others can access • Practitioners enter once Nat'l Cred Forum - Feb. 12, 2005

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 there’s pushback) Nat'l Cred Forum - Feb. 12, 2005

7. Organizations Weigh In • 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 Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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 it’s a good idea • Great if there’s a national data element bank; “we’ll play but can’t endorse” Nat'l Cred Forum - Feb. 12, 2005

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 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 Nat'l Cred Forum - Feb. 12, 2005

11. Organizations Weigh In • NPDB • Still 2 yr query – may change; looking into proactive disclosure • Betsy to discuss NPDB news later (good stuff) Nat'l Cred Forum - Feb. 12, 2005

12. General Discussion • We all: • OBTAIN • VERIFY • Some ASSESS • Some REVIEW • What do we have in common that’s workable??? No advantage to doing differently Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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 Nat'l Cred Forum - Feb. 12, 2005

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) Nat'l Cred Forum - Feb. 12, 2005

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). Nat'l Cred Forum - Feb. 12, 2005

17. Panel comments • Annette • Dick • Betsy • Rob • Open Discussion Nat'l Cred Forum - Feb. 12, 2005