The American Medical Accreditation Program (AMAP) entered a phase-in period this year with the surgical specialty societies supportive of the concept, but leery of some of the ramifications.
AMAP was designed by the American Medical Association to create an accreditation process for the nation's 600,000 physicians. AMAP's review and evaluation will cover five components: credentials, personal qualifications, environmental care, clinical performance and patient care outcomes of every physician who seeks accreditation.
The objective is to develop an accreditation process that is directed and operated by physicians and a "seal of approval" that is accepted by all physicians, health plans, hospitals, payers, regulators and the public. That would be important to physicians who face quality assessment reviews from many managed care organizations and hospitals.
"We're supportive of the concept because of our member concerns about the growing number of quality assessment reviews by managed care organizations," said William W. Tipton Jr., MD, executive vice president of the Academy. "Sometimes, there are several different reviews in the same month.
"We don't disagree with the first three components of the AMAP review of credentials, personal qualifications and environmental care. But the last two on clinical performance and patient care outcomes are of great concern.
"The Academy and the Surgical Specialty Care Coalition are concerned that AMAP will lead to another credentialing system and the impact of that on the American Board of Medical Specialties (ABMS). The surgical specialties all have credentialing boards; how will they be incorporated into the system?"
Dr. Tipton also is concerned that "AMAP is really an AMA membership enhancement program. The AMA membership has shrunk and the AMA would like to get the physicians back. Will the AMA use a price differential for the AMAP seal of approval to enroll more physicians?
"We need to evaluate the program. We will continue to work with the AMA to see how the program develops."
The Surgical Specialty Care Coalition drafted a resolution for the AMA's Interim Meeting in Atlanta in December, asking for a delay in implementation of AMAP until there were more details of the plan available. After a meeting with AMA officials, the coalition amended their report to ask for a seat on the AMAP Board of Governors for ABMS as well as expanded representation of the specialty societies on the AMAP advisory committees. This was later changed to seeking three seats for the specialty societies on AMAP Board of Governors which would be equal to the number of AMA seats. It was defeated by the House of Delegates 230 to 180.
"The vote showed a lot of support from the floor and it showed the concern that many societies have regarding the certification portion of AMAP," Dr. Tipton said.
Subsequently, the Board of Trustees voted to increase the seats on the AMAP Board of Governors and awarded these to the specialty societies. This provided the specialty societies an equal number of seats to the AMA Board of Trustees seats.
AMAP will become operational on a limited basis early this year and will be expanded during the next three to five years. Initially, the review process will cover standards for credentials, personal qualifications and environment of care.
Pilot testing will be conducted for making the patient satisfaction component of AMAP operational by 1998 and the balance of the patient care results and clinical performance components operational by 1999. By 2001, the AMA said, there should be sufficient data to formulate recommendations for using clinical performance and patient care results information in the accreditation process.
The AMA said each physician who elects to apply for accreditation will complete an application and pay AMAP a fee. The physician agrees to release the results of the review and the accreditation decision to the plans and hospitals which he or she identifies on the application form. It is expected that physicians primarily will choose to seek accreditation as a result of recruitment and retention decisions by health plans and hospitals that have elected to use AMAP accreditation as a measure of quality. Accreditation will be available to individual physicians who do not wish to share the results with third-parties.
Each health plan and hospital authorized to receive the AMAP results will pay a fee. The AMAP report will include the assessment process, the portfolio of qualifications and performance and the accreditation decision. The AMA said that "to apply its accreditation standards, AMAP will assemble an extensive portfolio containing all information required by National Committee for Quality Assurance, Utilization Review Accreditation Committee and Joint Commission on Accreditation of Healthcare Organizations, as well as those data elements required for AMAP accreditation. The uniform credentials form being developed by the Medical Society Credentials Verification Organizations of America will be used to define the credentials data set for AMAP."