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NCQA releases 2000 managed care guidelines
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As expected, the newly published 2000 Managed Care Organization (MCO) Surveyor Guide lines released by the National Committee for Quality Assurance (NCQA) now includes optometrists in the NCQA credentialing process. How ever, unlike the draft issued in May, ODs are not specifically listed in the document; rather, they fall under the umbrella of “licensed independent practitioners.”
The guidelines, which will be in effect from July 1, 2000, through June 30, 2001, are intended to assist MCOs in the NCQA accreditation process. While the lead-in paragraph uses the term “licensed independent practitioners” as a blanket label for practitioners of various delineations, optometrists are still segregated from MDs, DOs, DPMs, DCs, and DDSs referenced later in the document. While the revision is a step forward for optometrists, the omission of “OD” is disappointing, said Carol Brown, OD, chair of the American Optometric Association (AOA) Commission on Quality Assessment and Improvement.
“The omission should not keep optometrists off panels,” Dr. Brown told Primary Care Optometry News. “What is bothersome is that all doctorate level practitioners with the exception of optometrists are specifically referenced in the document.”
Is credentialing necessary?
While NCQA accreditation is voluntary, it is a hot topic in the MCO industry because an increasing number of leading health care plans are calling for or even requiring it of their HMOs. The accreditation process provides for the verification of the professional credentials of all practitioners an MCO contracts with, which will include optometrists, said Dr. Brown.
“What we were finding, at least anecdotally, was that MCOs were not putting optometrists on their panels purportedly because the NCQA did not have credentialing standards for optometrists,” she said. “It may be that optometrists have been simply overlooked by MCOs as they have focused past efforts specifically on the practitioners outlined in the Surveyor Guidelines. The 2000 guidelines may eliminate this problem by providing a broader interpretation of practitioners through the term ‘licensed independent practitioner.’ ”
This past spring, the NCQA posted a draft of the 2000 standards on its Web site, on which the public was free to comment and propose modifications. The AOA furnished the NCQA with a complete revision of the draft that included all of the necessary language to easily incorporate optometric inclusion in the final draft. The public comment period concluded April 30, 1999.
Dr. Brown said that when next year’s guidelines come up for review, the AOA intends on taking full advantage of the comment period and will recommend a separate listing for optometrists.
“The AOA is always working towards that end,” she said.
For Your Information:
- Carol Brown, OD, is the chair of the American Optometric Association Commission on Quality Assessment and Improvement. She may be reached at 4139 N. Holland-Sylvania Rd., Suite B, Toledo, OH 43623; (419) 885-5300; fax: (419) 885-5308; e-mail: cbod2020@aol.com.