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Watch out for credentialing red herrings

Credentialing Resource Center Connection, March 1, 2007

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Establishing clear and consistent criteria for both membership and privileges is inherent in crafting policies and rules, the first step to credentialing.

However, there are times when even experienced medical staff leaders and medical service professionals fail to heed established policies and procedures because they either were not aware of the existence of these policies or rules, or they did not recognize the link between an existing policy and the particular concern. Failure to recognize the link could be due to a red herring-a diversion or distraction from the real issue.  All credentialing specialists should be aware of the red herrings and be able to identify them for what they are: disruptions to the process.

For example, a seasoned credentials chair recently asked me what their organization's obligation was in terms of ongoing follow-up and communication from the medical staff office to a potential candidate who had not met their criteria.  The organization had placed the applicant's information in a "pending" file, and their already overburdened medical staff office would routinely check with the applicant as to their status for meeting established criteria.

Because of the red herring of+ outside pressures to get this particular applicant credentialed, the credentials chair was forgetting that the "burden is on the applicant" to prove that he or she meets the defined qualifications for membership and privileges. The only steps required of the hospital are notification to the potential applicant that because he or she did not meet required qualifications or eligibility criteria and therefore the application could not be processed.  The notification could also contain a statement that once the applicant did meet the established criteria, he or she was welcome to contact the medical staff office to request an application for membership and privileges.

Another proactive approach when dealing with applicants presenting incomplete applications or who fail to provide the additional information as requested is to have a standard letter stating that because the applicant has not responded within a defined timeframe to the request for additional information/documentation, the applicant has voluntarily withdrawn their application.

Tips for the week:

• be able to identify the "red herrings" and get to the real issue in credentialing and privileging
• follow established policies and procedures
• create an environment that allows for a suspension on decision-making in order to develop a well crafted policy                                                                                           

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