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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
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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