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Credentialing quick-checks

Credentialing Resource Center Connection, February 3, 2005

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Dear Credentialing Colleague:

Periodically, the credentialing committee and its assistants should pause and "take stock" of the credentialing policies, procedures, and outcomes at your hospital. This simple but effective mental quick-check of your credentialing program will help you evaluate the success of your program and make any necessary adjustments.

Have there been any complaints regarding your medical staff's/institution's credentialing program? Such complaints can come in many forms and from a variety of sources, and could signify a lack of precision in the credentialing process. Sources of complaints to be considered include:

* the business office of either the hospital or existing physician practices due to unnecessary delays between application and appointment

* prolonged turf battles that were not subject to rapid resolution

* recommendations or findings from your institution's accrediting or licensing agency

* department chairs that have not been given adequate training in the performance of their credentialing functions

* board members who are asked to appoint or reappoint a physician without proper evidence of his or her performance

* the Office of the Inspector General or the FBI as they probe alleged EMTALA or other quality issues

* fair-hearings resulting from unnecessary denials

* successful antitrust actions brought by healthcare providers

By tracking complaints and their sources, you will gain better insight into how your program is working and what areas are in need of attention. The absence of any complaints should, at the very least, indicate that your policies, procedures, and outcomes are appropriate and working efficiently. However, this does not mean that your credentialing system could not be made better or more efficient.

That's it for today.

All the best,

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