URAC HCP 2 -- Proposed v. 2.1 Revision -- NEW STANDARD -- Notice of Performance Measurement Program Changes

This new standard would read:

The organization must give physicians and other providers 45 days notice regarding material changes to its measurement programs. [4]

Like HCP 1, this is a reflection of URAC's value of transparency: your processes should be open to scrutiny, particularly by the people and institutions that are likely to be directly impacted by those processes. However, by requiring advanced notice, we start to get into the realm of due process, by making sure that affected providers have enough time to object to the organization's proposed changes before they go into effect.

The scope of the standard is fairly broad, as a number of types of changes in the performance measurement system are covered: "Examples of “material changes” to an organization’s measurement program may include, but are not limited to, a change in measures, units of measure, sampling methodology, or use of the information."

The impact of this standard is to take away some of the organization's flexibility in changing measurement processes "on the fly." Affected HMOs and PPOs will have to build this lag time into their implementation plans.

How will URAC reviewers assess compliance? We have a hint from P-MR 4, which requires that the organization notify consumers before making a change in covered benefits. For that standard, the reviewers request a list of all benefit changes, and then ask for a dated copy of a letter or other notification to consumers for one or more of those benefit changes. One can expect a similar approach here -- the reviewer will request a listing of all changes to methodology, then dated, written copies of notifications to affected providers of those changes.

So, as you can see, the premium will be on documentation, both of your changes in methodology and notification of providers. Remember the URAC mantra: "If it isn't documented, it didn't happen."