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Revamped PPO accreditation standards proposed


WASHINGTON—Proposed changes to the National Committee for Quality Assurance's preferred provider organization accreditation program would put PPOs on equal footing with health maintenance organizations, the Washington-based organization said.

Unlike HMOs, PPOs seeking NCQA accreditation currently are not required to report on clinical quality results using the Health Plan Employer Data and Information Set. The absence of a primary care physician—a central component of most HMOs—made such reporting difficult for PPOs, an NCQA spokesman explained.

As a result, PPO reporting to the NCQA had focused mainly on processes and standards. However, improved information systems being used by health plans now are making such reporting possible, the spokesman said. In fact, 80 PPOs voluntarily submitted HEDIS results to NCQA last year.

The proposed accreditation program changes also would require PPOs to report results from the Consumer Assessment of Healthcare Providers and Systems, which evaluates patients' experience with care and service.

HEDIS and CAHPS scores would be given more weight in the evaluation process under the proposed changes. Currently, these scores represent approximately one-third of the score a PPO needs to become accredited. Under the changes, that proportion would rise to 50%.

NCQA said it is proposing the changes since the majority of privately insured U.S. residents are enrolled in PPOs. In addition, the federal government now requires PPOs participating in the Federal Employees Health Benefits Program and Medicare to report HEDIS data.

The public comment period on the proposed changes began Thursday and will run until March 30. Health plans, employers, consumers and other stakeholders are invited to offer input. Final standards are to be released this summer with an effective date of July 1, 2008.

To download a copy of the standards and submit input, visit NCQA's Web site at