URAC HCP 3 -- Proposed v. 2.1 Revision -- NEW STANDARD -- Physician and Other Provider Rights Regarding Performance Measurement

This new standard provides:

At least 45 days prior to releasing performance data to the public, the organization must disclose to physicians and other providers an explanation of and provide access to: [--]
(a) How physician and other provider perspectives were incorporated in the development of the health care performance reporting program; [4]
(b) Data used for physician and other provider ratings; [4]
(c) The methodology and measures used to assess physicians and other providers, including attribution; [4]
(d) How the data will be utilized; [4]
(e) The physician’s and other provider’s right to make corrections; and [4]
(f) The physician’s and other provider’s right to: [--]
(i) A reconsideration with the organization; and [4]
(ii) To make an appeal to the organization; [4]

This standard offers a blend of transparency and due process, requiring the plan or network to notify affected providers of  a variety of elements of the program to use provider performance data.  Much is suggested by this standard, not the least of which is a process to assure that there is effective notification 45 days prior to use or publication.  I predict that this will be a sticking point for some organizations who fail to plan ahead and find market pressures to get a tiered network to market pushing up against this requirement to do so in a way that encourages provider input.

Again, URAC has not yet developed (or at least published) its review process information, but my guess is that the desktop reviewer will want to see a full policy and procedure describing this process, and that the onsite reviewer will ask for documentation of launch dates of tiered networks or published performance data, then look for documentation of full notice to providers 45 days prior.