The Basics

This particular subsection (formerly Core 33(e)) requires that the QM committee include, where applicable, "at least one participating provider or receives input from a participating provider committee (such as a Physician Advisory Group)."

This subsection applies to Health Plans and Health Networks.  The question comes up, "if we don't have a participating provider on the QMC itself, how do we make sure that the input from the participating provider committee is adequate?"

Our answer to this question is, "make sure that anything that is the responsibility of the QMC to receive reports about, or do, or issue reports on, gets to this physician group."  That can be a lot.  As our blog post on QMC responsibilities shows (click here), that may involve a lot of activity.

So, if your physician advisory group is not particularly active, either gear it up to meet the full range of the QMC's clinical responsibilities or play it safe and appoint a participating provider to your QMC.