ODs may be eligible for NCQA credentialing

Issue: June 1999

The National Committee for Quality Assurance (NCQA) is currently revising Accreditation 2000 Standards for credentialing and recredentialing that will apply to all licensed independent practitioners. The updated standards, which will take effect in final form July 1, 2000, may address optometry for the first time.

Bonnie Kohler, administrative director for the Clinical Care Center for the American Optometric Association (AOA), said if optometrists are included in the finalized standards, they would be able to participate more within the health care organizations and would have more of an opportunity to vocalize their point of view.

“Many optometrists have felt that they have been kept off of a lot of the boards or panels of health care organizations because NCQA did not offer credentialing standards for optometry,” she noted. “When these standards are passed, optometrists are going to be part of the accreditation process. They will have the same opportunities as other health care providers to serve on the board and to obtain more of a leadership position.”

Ms. Kohler said that one of the suggestions made by the AOA was to change the wording from optometrist to OD. “Because MD and DO are used, we want to use OD,” she said. “After the NCQA receives feedback [the public comment period concluded April 30], it will propose modifications to the Standards Committee and the NCQA board of directors, which will make final decisions regarding Accreditation 2000 Standards.”

Brian Schilling, spokesman for the NCQA, said that the health plan to which the optometrist belongs would be required to credential optometrists the same way it would any other provider. “Having said that, some of the credentialing areas may not apply to optometrists the same way that they would to other providers,” he said. “Some of the areas are fairly broad, such as work history, malpractice insurance and so on. Those are obviously applicable.”

Basis for quality assurance

Ms. Kohler said that this credentialing process also gives optometrists a basis for developing solid quality assurance programs in their offices. “Optometrists must be sure what type of patient satisfaction they will have, because complaints will be noted, especially with health maintenance organizations,” she said. “Optometrists will have to follow specific rules that have been set up by that organization. Then, to make sure they’re in compliance, the NCQA will do an accreditation survey to make sure they are meeting those standards. So it helps improve an optometrist’s practice and make him or her more aware of what’s being done in the office or more aware of how the patient is perceiving the care.”

The process may seem to simply create more paperwork, but Mr. Schilling said that it should assure practitioners about the health care organization with which they are affiliated. “It does mean more work,” he said. “But practitioners want to know that the other providers in the network are good quality providers so you can rely on them. You also want to know that you’re working with a health plan that cares enough to be selective about the providers it allows in its network. In the long run, thorough credentialing is in everyone’s best interests.”

Appeal rights

“To protect providers, there are actually provisions within our standards that say the providers have an appeal right if they don’t agree with some of the findings,” Mr. Schilling continued. “The health plan has to tell a provider the reason why they’re not being allowed into the panel. We want to try and make these processes as open as possible so the providers don’t feel like they’re being kept in the dark.”

For Your Information:

Bonnie Kohler may be reached at the American Optometric Association, 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881; (800) 365-2219, ext. 237; fax: (314) 991-4101; e-mail: BDKohler@theaoa.org.

Brian Schilling is the communications manager for the National Committee for Quality Assurance. He may be reached at 2000 L St., Suite 500, Washington, DC 20036; (202) 955-3500; fax: (202) 955-3599; e-mail: schilling@ncqa.org.