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Credentialing Resource Center Connection, May 22, 2008

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Anne Roberts, CPMSM, CPCS, is the director of medical affairs at Children's Medical Center in Dallas, where she oversees the medical administration, graduate medical education, and medical staff services departments.

Dear Credentialing Colleague:

Recent controversy regarding lawsuits have forced hospitals to take a closer look at the type of information they are disclosing (or failing to disclose) when submitting responses to hospital affiliation verification letters.

Affiliation verification letters provide a verification of dates that a physician was affiliated with an organization, staff status, privileges, whether they have had any formal disciplinary action at that organization and other details regarding their affiliation. Common practice over the years has been to include a statement that the individual is on staff and “in good standing.” This could mean several different things. For example, it could mean that the practitioner was “in good standing” at the time the verification was provided, but this does not mean that the practitioner has always been in good standing. In addition, it has not been common practice for hospitals to disclose information regarding whether a practitioner had previous formal action taken by the hospital or if there is action pending.

Take for example the case of Kadlec Medical Center v. Lakeview Anesthesia Associates (an overview of the case is available here). The court originally ruled against the hospital that provided a generic template letter and the physicians who provided more detailed peer reference letters. However, this was overturned earlier this month when an appeals court ruled that the hospital’s generic letter was not false or misleading.

The preceding case is a strong example of why hospitals must be very cautious to ensure that they disclose information, as appropriate, when responding to affiliation verification letters. You should always use caution when releasing confidential information to outside organizations and ensure that you read the release of information submitted with the request to make sure that it specifically releases your organization from liability for providing information in good faith. There have been many times when I reviewed a verification request and realized that the other organization attached an attestation from the applicant rather than the applicant’s release form.

If a physician or other practitioner has a history of disciplinary action, failure to share that information restricts the other organization from performing a thorough review and from making an informed decision to grant membership and/or clinical privileges. The type of disciplinary action information that your organization is willing to share with other organizations should be consistent. The hospital should ensure that the types of information disclosed as well as the detail of information disclosed is consistent between providers and per provider. Generally, with the assistance of legal counsel, hospitals develop and use standard language for each practitioner that has reportable actions.

At the time that the practitioner receives the disciplinary action, you should make sure he or she understands that it is something he or she is required to disclose and that the hospital may disclose it to other entities upon request. The first step in determining a disclosure policy is to meet with your organization’s legal counsel to determine what type of information your organization will disclose, to whom, and when.

As the hospital on the receiving end of affiliation verification letters, thoroughly and carefully review generic template letters from other healthcare organizations. Does the template letter indicate that the applicant is in good standing and has not had any prior or pending disciplinary or quality issues at that facility? If not, then you may want to follow up and confirm this information. If you’re unable to obtain the information, put the burden back on the applicant to ensure that you receive a statement from the other hospital indicating that he or she has not had any past, pending, or current disciplinary or quality issues.

If you accept a generic template letter and do not take the initiative to ensure you received a thorough response, then you have failed to ensure that you have performed thorough credentialing on behalf of your organization.

Remember, clear, effective communication is the key to success!

That’s all for this week.

All the best,

Anne Roberts, CPMSM, CPCS

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