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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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”

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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)

16. 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).

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