In a boost to physician groups, the National Committee for Quality Assurance wants to make it easier for health plans to delegate certain functions like utilization review and credentialing to contracting doctors.
Last week, the managed-care accrediting organization released draft standards for its physician organization certification program, which is scheduled to start in October.
Certification replaces the redundancy of multiple health plans annually auditing each medical group or physician network in order to meet NCQA accreditation standards.
Physician organizations may be certified in any or all of six areas: quality management and improvement, utilization management, credentialing, preventive health, members' rights and medical records.
Physician organizations probably will pay about $10,000 for a survey, with higher prices for large groups. Currently, HMOs pay for audits of physician groups.
Initial certification will last one year. Following a second successful survey, it may be extended to three years.
The program's significance goes beyond the hassle factor.
Certification will alleviate fears that physician groups will be forced to establish varying procedures and standards for each plan, said Richard Dixon, M.D., medical director of the Oakland, Calif.-based National IPA Coalition. Moreover, he said, the move sends a message to health plans that it's OK to delegate.
Delegation is common in California and Minnesota, but elsewhere many plans have been reluctant to give up control. The NCQA estimates 700 physician organizations perform delegated tasks or soon will do so.