Hot Off The (Proverbial) Press

I was all set to write an entry on the unintended consequences of NCQA’s changes to standard CR 6 but that got scooped by a recent decision. 

Here’s the issue.  CR 6, Practitioner Office Site Quality, was changed for standards year 2008 eliminating the requirement to conduct site visits for all PCPs, OB/GYNs and high volume behavioral health practitioners.  In its place is a requirement to conduct site visits for practitioner offices about which the organization receives a complaint related to:

§         Physical Accessibility

§         Physical Appearance

§         Adequacy of Waiting and Examining Room Space

§         Availability of Appointments

§         Adequacy of Treatment Record Keeping

The process, as described in the 2008 standards, required a full-scope site visit for any single member complaint related to any of the five categories listed above.  There is no provision for an organization to validate the complaint before conducting the site visit. 

The intention was to reduce the burden that site visits place on organizations by focusing on sites where there is a reason to suspect an issue.  The unintended consequence is that, for many organizations, the number of site visits would increase exponentially due to member complaints about availability of appointments—many of them not valid. 

Good News!!!

NCQA has decided to NO LONGER REQUIRE A SITE VISIT in response to complaints about Availability of Appointments and Adequacy of Treatment Record Keeping.  This will significantly relieve organizations from an otherwise almost unmanageable site visit burden. 

NCQA still has not addressed the issue of multiple complaints being received in a short period of time about the same practitioner site.  As the standard is currently written, each would trigger a full-scope site visit.  The benefit of conducting serial site visits in a short period of time is questionable. 

The lack of a process for the organization to validate a complaint before conducting a site visit is also of concern. 

I’ll keep you posted on additional changes.