An American Medical Association database on practicing physicians may now be used by hospitals and other providers to meet accrediting standards, the Joint Commission on Accreditation of Healthcare Organizations has decided.
Previously, the JCAHO required hospitals to verify physicians' credentials with primary sources-state licensing boards, medical schools and residency programs. They could use the AMA database as a backstop.
Now, a verification through the AMA database will be considered an acceptable substitute for primary-source documentation. This should simplify credentialing and record-keeping for hospitals.
Since 1906, when it wrote the information on index cards, the AMA has been collecting detailed histories of every practicing physician in the country. It has a staff that tracks their progress through medical school, residencies, fellowships, states they are licensed to practice in and sanctions they might receive.
"The information does not come from physicians. That's key to its whole ability for use with credentialing," said Thomas Reardon, a general practitioner from Portland, Ore., and newly elected vice chair of the association. "If a doctor says on his profile, `I went to Harvard,' well, we'll call Harvard."
The AMA also gathers sanction information from the federal government, including Medicare, Medicaid, the Public Health Service and the Veterans Administration hospitals, and tracks all final actions taken by state licensing boards. It learns from the Drug Enforcement Administration whether doctors have permission to prescribe controlled substances.
The computerized files contain data on 735,000 physicians from 2,100 primary sources. Staffers make 2 million changes to the file each year, including 250,000 address changes. Last year, the AMA researched 30,000 physician profiles for one managed-care plan in California.
"Obviously, using a centralized database like this is more efficient, for the individual hospital and for the primary sources," said Paul Schyve, M.D., senior vice president for the JCAHO. "The medical school may get a request from one place, rather than responding to requests from multiple hospitals."
In the past, the JCAHO encouraged hospitals to consult the AMA master file but did not accept it as a substitute for primary-source verification.
"It provided a lot of information you might not actually get from the applicant or the primary source," Schyve said. "Suppose the applicant reports on an application to a panel that they are licensed in three states. The network would confirm with the licensure boards in the three states.
"But suppose the physician had been licensed in a fourth state, and that license has been revoked. The applicant might not have said that, and there's no way for the hospital to suspect it. The AMA master file would reveal that," Schyve said.
The JCAHO decided to accept the AMA master file as a substitute for primary verification after the AMA made some procedural changes to satisfy its requirements.
The fundamental issue, from the JCAHO's standpoint, is "do hospitals do a good job making sure that qualified people are providing services in their organization?" Schyve said. "One of the steps in that is the credentialing process.
"If we come into a healthcare organization that is asking us to survey them, and they are relying on the AMA physician master file to say, `We did comply with the expectation that we verify with primary sources,' we say, `Fine."'