Add the emerging credentials verification industry to the list of obstacles to the American Medical Association's much-heralded American Medical Accreditation Program.
AMAP's strategic goal is to keep government-and anyone else for that matter-out of the business of quality oversight of physicians. But to do that, it must compete with commercial credentials verification organizations that have capital, expertise and a big head start.
AMAP intends to collect data from physicians and issue a gold star to those physicians who meet certain standards. Many observers are already skeptical that the AMA can effectively police the quality of its own members.
It also will have two revenue-generating functions, both of which are now being tackled by commercial ventures. One is verifying credentials for health plans and hospitals according to standards of the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. The other is eliminating dozens of redundant forms that physicians and their staffs must complete for credentialing by managed-care plans and hospitals.
Two companies, Atlanta-based HCMS and Louisville, Ky.-based Aperture Credentialing, have just launched on-line products to streamline paperwork. They allow physicians to submit information to automated systems that use it to complete prepared forms for designated hospitals and health plans. Dallas-based Sweetwater Health Enterprises plans to launch a similar product by July 1.
With each system, physicians have to enter data only once. The forms can be printed in the physician's office, where the physician signs and forwards them to the health plan or hospital for verification.
HCMS charges $120 per year for up to three applications and $395 for unlimited applications. Aperture charges a $150 annual fee plus $25 per application.
For AMAP, doctors pay an annual fee of $125, or $50 for AMA members. However, AMAP currently has no mechanism in place to streamline credentialing for physicians.
AMAP expects to accredit its first round of physicians in New Jersey by early June and be operational in up to four more states by year-end.
Officials at all three commercial credentialing organizations acknowledged that their products resemble the vision for AMAP, minus the gold-star rating system. How-ever, they would not call themselves AMAP competitors.
"As a company we will never step over the line and say this is a good or a bad doctor. We're an objective company collecting the facts," says HCMS President Mark Kulik.
In an interview with MODERN HEALTHCARE this month, Randolph Smoak Jr., M.D., vice chairman of the AMA board of trustees and chairman of the AMAP governing body, acknowledged that those programs address some of the same issues as AMAP. They are streamlining credentialing for medical groups and small physician practices.
However, he called those products "very limited" compared with what AMAP will be.
Smoak says the income from AMAP physician fees will be small. Most AMAP revenues will come from selling verified data to health plans and hospitals, he says.
But it's unclear what, if anything, AMAP will provide that the commercial credentialing organizations don't already, at least at the outset.
AMAP promises to add outcomes data to the mix, but that won't be ready for at least two years, probably longer, Smoak says. Also, hospitals and health plans already have begun collecting their own outcomes data on physicians.
"It (AMAP) actually isn't going to save the hospital anything," says Lynn Buchanan, a Denver consultant and president-elect of the National Association Medical Staff Services.
Additionally, the AMA has pledged to work with credentialing ventures established by state medical societies. Medical society credentialing organizations have verified data for local hospitals for years. However, many of them do not have the capital to compete with big commercial operations, says Vicki Searcy, a principal of Chicago-based BDO Seidman.
As of April, only four state medical society credentialing organizations had been certified by the NCQA to conduct delegated credentialing for HMOs.
In fact, AMAP might become a prime customer for commercial ventures. Kulik says AMAP officials have inquired about how the AMA could use his company's technology. And Smoak acknowledged that AMAP might partner with commercial ventures in some states.
Searcy says a negative perception of the AMA's physician database could also spell trouble for AMAP. Only 46% of hospital respondents in last year's BDO Seidman survey said they use the database even though the Joint Commission designated the AMA's comprehensive database acceptable as "primary source verification" for medical school education and internship or residency.
Of those who don't use it, 32% said they do not believe the data are accurate.
The database, known as the Masterfile, contains personal information and professional background on medical schools, hospital internships and residencies, board certifications, state licensing activity, and state and federal disciplinary sanctions on about 700,000 doctors. The data are available for a fee of $12 per physician.
But Smoak says the AMA's own commissioned studies reflect a "high level of satisfaction" with Masterfile data.