Cca namss credentialing consensus alliance
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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.

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CCA-NAMSS (Credentialing Consensus Alliance)

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Cca namss credentialing consensus alliance

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


Namss vision

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


    Organizations represented

    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


    Summary of expectations

    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


    Organizations weigh in

    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


    Organizations weigh in1

    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


    Organizations weigh in2

    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


    Organizations weigh in3

    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


    Organizations weigh in4

    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


    Organizations weigh in5

    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


    Organizations weigh in6

    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


    General discussion

    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


    General discussion1

    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


    Concepts for discussion

    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


    Next steps

    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


    Next steps1

    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


    Panel comments

    Panel comments

    • Annette

    • Dick

    • Betsy

    • Rob

    • Open Discussion

    Nat'l Cred Forum - Feb. 12, 2005


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