Provider Availability

This standard, which is the same for both Health Plan and Health Network accreditation programs, provides:

With respect to both access and availability of providers to provide care to consumers, the organization:
    (a) Establishes goals;
    (b) Measures actual performance in comparison to those goals: and
    (c) Makes improvements where necessary for the provider network.

The standard has a weight of 4, and all of the elements are primary.

It is useful to think of this standard as having six subsections, not three.  Here is how I would rewrite it to reflect this view:

(a) With respect to access (i.e., geographic dispersion or travel time) of providers to provide care to consumers, the organization:
    (i) Establishes goals;
    (ii) Measures actual performance in comparison to those goals: and
    (iii) Makes improvements where necessary for the provider network.
(b) With respect to availability of providers to provide care to consumers (i.e., ability of consumers to receive care in a timely fashion), the organization:
    (i) Establishes goals;
    (ii) Measures actual performance in comparison to those goals: and
    (iii) Makes improvements where necessary for the provider network.

If you think about the standard this way, you are far less likely to make the most common NM 2 error, to submit documentation that relates only to geographic dispersion, and not the ability of consumers to receive care in a timely fashion.

So, what kind of documentation are we talking about here?

For “access”, since your goals will be expressed either geographically (e.g., “2 providers per specialty per county”) or drive-time (e.g., “no more than 30 minutes drive to a primary care provider in urban areas and no more than 45 minutes in rural areas”), documentation of measurement of your performance against those goals will be in the form of a GeoAccess or similar report.

On the other hand, for “availability”, since your goals will be expressed in terms of hours of availability (e.g., “office open at least 30 hours per week”) , wait times for appointments (e.g., “no more than a two week delay for a non-urgent appointment”),  or customer satisfaction regarding the ability to receive care in a timely manner (e.g., “85% customer approval of provider availability”),  documentation of measurement of your performance against those goals are likely to be in the forms suggested by the Program Guide:

•    Member surveys addressing provider availability
•    “Secret shopper” calls testing provider availability during “off-hours” times and testing ability of member to get timely appointment
•    Reports of onsite examination of appointment records

As much as is humanly possible, however, in any event, you should strive to present performance measurement in the same units of measurement as you express your goals for both access and availability.