August 1998 Bulletin

AMAP seen undermining Board certification

AMA exec disagrees, but says conflict of interest concern is real

The American Medical Accreditation Program (AMAP) gets an unequivocal "thumbs-down" from Michael A. Simon, MD, president of the American Board of Orthopaedic Surgery.

AMAP is a national accreditation program designed to relieve physicians of the burden of having to comply with multiple requests for credentials and practice site surveys from all of the health insurance plans and hospitals. AMAP is intended to be the sole source of standardized physician quality information.

However, Dr. Simon, speaking at a panel discussion during the annual meeting of the Academic Orthopaedic Association in June, says AMAP will appear to the public to be self-serving and it undermines the physician certification process. Co-panelist William F. Jessee, MD, vice president, quality and managed care, American Medical Association, disagrees. He says AMAP is not a substitute for certification.

The program was developed in response to complaints from physicians about the time and paperwork demanded by their health insurance plans. Dr. Jessee says physicians have an average of 12 plans to deal with and some practices have 15 to 20. Also, Dr. Jessee says "everyone was profiling utilization, but not in the same way. Each managed care organization looked at only their patients in your practice."

Up to now, the standards for quality have been set by insurance companies, consumer groups and the government and not by the profession, says Dr. Jessee. "We started with the idea that professionalism requires that the profession set the standards for members of the profession," says Dr. Jessee. "The profession includes the AMA, specialty societies, Boards and others. Professionalism requires that we have standards, evaluate ourselves and we continue to improve."

Dr. Simon counters that AMAP "will be perceived as self-serving because the profession is setting the standards." Also, he says "the standards are quite low, in our opinion; few candidates will fail to receive accreditation." Dr. Simon believes the use of the terms "accreditation" and "certifying" are confusing and will obscure the significance of Board certification.

Dr. Jessee concedes the concerns for conflict of interest and misrepresentation are real and suggests that perhaps "a new entity will pick up the program and go on."

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