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Clinical Care and Practice Advancement

Frequently Asked Questions

1. Why do I as an optometrist need a quality assessment and improvement program for my office?

A significant majority of HMO lives are enrolled in managed care organizations (MCOs) that have undergone accreditation by the National Committee for Quality Assurance (NCQA). Optometry is included in the NCQA accreditation standards as licensed independent practitioners. Each optometrist must be ready to meet these standards in the areas of office review, quality assessment and improvement.

The Practice Review Education Program (PREP) was designed to give you, the practicing optometrist, a means to complete a self evaluation of your office. (See Practice Review Education Program.)

Implementation of a quality assessment and improvement program will favorably impact your practice by providing:

  • Improved quality of care and patient satisfaction
  • Decreased risk/liability exposure
  • Increased access to patients via improved marketability of your practice to third party payors
  • Increased practice income

2. What are the components in a quality assessment and improvement program?

A quality assessment and improvement program is basically made up of the following elements:

  • Credentialing/Privileging - credentialing is the process by which an individual's qualifications to practice are assessed and verified. Privileging is the process by which an institution grants an individual clinical privileges.
  • Patient Records: Documentation and Record Review - the ability to demonstrate that quality care is being provided and that the care is appropriate for the patient's clinical condition.
  • Patient Satisfaction/Quality of Service - patient satisfaction is the summary of the patient's overall satisfaction with his or her eye care visit and the patient's perception of the quality of the care he or she received throughout the entire interaction with the doctor and the office staff.
  • Risk Management - clinical and administrative activities to identify, evaluate, and reduce the risk of injury and loss to patients, personnel, visitors, and the institution itself.
  • Utilization Management - a program that effectively manages the resources of a practice (e.g., staff, equipment, services, etc.) in order to provide appropriate care according to patient need.

3. Many HMOs (or other networks) or third party payors require that I provide them with a basic set of credentials in order to obtain clinical privileges and to be a participating provider of services. What is involved in credentialing?

Credentialing is the process by which an individual's qualifications to practice are assessed and verified.

4. Are guidelines for delineation of clinical privileges available?

Call the AOA St. Louis office at 1/800/365-2219, ext. 4237 or 4245 for a copy of AOA's Guidelines for Delineation of Clinical Privileges. Be sure to check with your individual state to confirm which procedures may or may not be applicable for that state.

For further information or samples of forms for the above questions, you may call Uzma Zumbrink, MPH at (314)983-4146, or send an email request to UAZumbrink@aoa.org.