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

This new standard sets forth a series of requirements for disclosure to providers at least 45 days beforethe organization releases provider performance data to the public.  Those disclosures must include:

• the means utilized to gain input from providers on the development of the performance reporting program.
• the data, methodology, and measures used
• the intended use for the data
• the process for correcting erroneous data and for requesting reconsideration and appeal by the organization.

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.