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Is your medical staff ready for the 'perfect storm'?

Credentialing Resource Center Connection, September 5, 2003

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Dear Credentialing Colleague:

A number of storm fronts are converging on the good ship "Credentialing" these days. One is the recent prediction of huge physician shortages over the next decade. Another is renewed pressure from physician recruiters. A squall from the east is filled with pent-up anger over high insurance costs, while a low-pressure system will exacerbate efforts to trim the medical staff office in the name of efficiency and lower management costs.

The captain of the ship will lose focus as the crew (i.e., the medical staff) refuses to step forward and make tough decisions during challenging times. The crew is tired, frustrated, unappreciated, fearful of lawsuits, and generally preoccupied with running their own practices. It is becoming more difficult to find willing volunteers for the tough work ahead.

The convergence of these fronts will result in a "perfect storm" for those involved in credentialing activities. So take a moment while the waters are still calm to review your organization's policies and procedures. Ask yourself the following 11 questions and consider my related comments/advice:

1. Is your credentialing process strong and robust, supported by medical staff, administrative, and board leadership? Without this essential commitment, you should not venture into the vast unknown! Conduct a full self-assessment of your policies and report your results to the board.

2. Has anyone briefed the medical staff on the likely effects of the rapidly approaching physician shortage? In the face of real shortages, we will be tempted or even blackmailed into relaxing credentialing standards and our scrutiny of new applicants.

3. Have you conducted a full review of your existing process to ensure no essential corners are cut to "improve efficiency?" Reducing the amount of time it takes to process a clean application should not mean reducing the level of scrutiny given to all applications!

4. Do medical staff leaders reinforce the importance of education regularly? Ongoing education, training, and inservices are key to eliminating process degradation and error. Organize regular, short educational activities for all medical staff members.

5. Has your board decided to conduct routine criminal background checks on physicians? More and more hospitals now conduct such checks, and it's time for everyone else to recognize their importance. These checks are standard for physicians seeking employment, a contract, or a position with many universities and the federal government.

6. Does the organization use temporary privileges to fill critical patient care needs? Few businesses ever prospered by remaining unresponsive to their clients (i.e., patients).

7. Have you instructed your physician recruiter to fully screen physicians before presenting their applications to the staff? There is no sense in putting someone through the process if they don't meet your organization's criteria in the first place.

8. Are credentialing and privileging activities occurring as designed? A medical staff office self-assessment could prove most informative.

9. Is a high-level leader ultimately responsible for credentialing activities? A high-level person must own the outcomes of the credentialing activity and be held responsible if it fails.

10. Are you willing to worry less about telemedicine and other "JCAHO-driven" credentialing issues, thus permitting greater concentration on the essentials?

11. Does your organization have the intestinal fortitude to stay the course while navigating treacherous waters?

The last question is the most important.

That's all for this week.

All the best,

Hugh Greeley

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