The American Medical Association expects to unveil its seal of approval for physicians this summer, starting in Massachusetts.
Universal accreditation of individual physicians is bound to be a gargantuan, highly complex task. Moreover, skepticism abounds about whether physicians can rate themselves.
Despite those issues, the AMA is forging ahead. Recently it sent a draft version of its accreditation standards to 1,500 interested parties, including health plans, medical societies and business coalitions.
"It's part of our status as professionals to set standards and then to manage those standards," said Randolph Smoak Jr., M.D., the AMA's secretary/treasurer, who chairs the governing body of the new program.
The AMA's American Medical Accreditation Program actually wants to tackle two jobs.
First, it's attempting to standardize physician credentialing performed by hospitals and health plans in order to reduce paperwork for doctors and medical groups. The AMA's program calls for "portfolios" of credentialing information that will be available for a fee.
Second, the program is making a big leap into accreditation-that is, rating physicians on quality. Those who meet the standards will receive a certificate to hang on the wall and a seal posted on the AMA World Wide Web site.
To be accredited, physicians must meet a set of required criteria, such as a medical degree and completion of a practice assessment scored by a third party. They must also fulfill a certain number of supplemental criteria, such as a clean disciplinary record, continuing medical education credits and board certification.
Fees have not been set, but physicians can expect to pay $50 to $100 to participate, with a discount for AMA members. Most of the anticipated revenues would come from health plans and hospitals, which would be charged around $200 per doctor to access data, with possible volume discounts.
The program's governing body is expected to meet and approve standards in late April. After Massachusetts, the program is slated to start in Alabama and New Jersey, with eventual expansion nationwide.
The AMA's stated plan is to add clinical performance and outcomes criteria in a few years.
Initially, the AMA must demonstrate it will save money and provide adequate information for organizations that do credentialing. Physicians in California, Oregon and Washington recently launched programs to streamline credentialing, but only after collaborating with health plans and hospitals. Bo Piela, communications director for the Massachusetts Association of HMOs, said his members are "a bit nervous" about yielding responsibility for credentialing.
Also, the AMA must instill credibility in its accreditation. It has tried to do this by appointing nonphysicians to the governing body that oversees the program. The 17 voting members include one hospital representative, one managed-care representative, two from accrediting bodies, one from not-for-profit health systems, one consumer representative and one employer representative. At least eight physicians must serve on the governing body, which is appointed by the AMA board. The program's budget is set by the AMA.
Further distance from the parent might be required. In 1990, the Medical Quality Commission, which accredits capitated medical groups, was spun off from its owner, the Unified Medical Group Association, because of conflict-of-interest concerns. The UMGA, which represented capitated groups, has since merged with another organization to become the American Medical Group Association. The AMGA is the commission's sole shareholder, but the commission has its own governing board and finances.
Joe Heyman, M.D., president of the Massachusetts Medical Society, argues that self-evaluation puts a larger burden on physicians to make the program work.
"If we're going to set standards for the profession, the best group of people to set standards is the profession itself," he said.