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NAMSS reaches out on the issue of board certification

Credentialing Resource Center Connection, March 29, 2007

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc. specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

Approximately one year ago, in a series of articles for The Credentialing and Privileging Advisor, the 10 elements of the "Evolving Credentialing Standard" were reviewed. The fourth element of that standard is verification of specialty board status. Although The Joint Commission does not mandate that organizations require board certification of practitioners, it maintains that if board certification or active participation in the examination process is required by your organization, then verification must be obtained.

There are many factors to consider when medical staffs decide whether or not to require board certification. Areas for discussion may include:

1) Should initial applicants be currently board certified or candidates for board certification? And if the latter is the case, what is the appropriate time frame in which they must achieve certification? (i.e., within five years of initial appointment, or within five years of completing post-graduate training)

2) Are applicants required to be board certified within their primary area of practice? (e.g. cardiology boards vs. internal medicine boards)

3) Is maintaining board certification an ongoing requirement?

The requirement that initial applicants be board certified, or participating in the certification process, when applying for medical staff membership is one that we, at The Greeley Company, have seen used increasingly around the country. On a smaller scale, the requirement to maintain board certification is also becoming more common. 

The National Association Medical Staff Services (NAMSS) has recently conducted a survey of its membership related to board certification requirements. Carole La Pine, MSA, CPMSM, CPCS and President of NAMSS, shares with us the impetus behind the survey and provides her thoughts on the results.

Carole writes:

It has been my experience that board certification is one credentialing element that is often required for medical staff membership and/or privileges. In an effort to determine "best practice," Sally Pelletier and I developed a survey tool for NAMSS to research what other facilities across the country were doing relative to board certification requirements. The survey was posted on the NAMSS Web site and NAMSS members were invited to participate.

The basic assumption is that many hospitals consider board certification to be the "gold standard."  Where patients have choices for their health care services, board certification is one credentialing criterion that distinguishes one facility from another and one practitioner from another. 

Because board certification is used primarily as a marketing tool by hospitals and is considered a measurement of a basic level of knowledge and skill, board certified practitioners have a competitive edge over non-certified practitioners. There is also an assumption that patients will have a greater sense of assurance that a practitioner is providing treatment that is safe, effective, and "best practice" when he or she is board certified.

In areas where physicians compete for patients or where board certification is required to participate in certain health delivery systems and health plans, board certification becomes a key credential.

Of the hospitals participating in the survey

• 10% are teaching facilities
• 36% have 251-500 beds
• 31% have 101- 250 beds
• 23% have less than 100 beds

Of the hospitals responding to the survey, 86% reported board certification is a requirement stated in either the hospital's bylaws or credentialing policies, and there is an underlying expectation that applicants must be board candidates (i.e., eligible and qualified).

According to the survey, 66% require board certification for initial applicants while 78% require board certification within a specific time period. Of those hospitals who require board certification within a specific time frame, 100% stipulate certification must be achieved within five years of employment.

Sixty-six percent of respondents connect the board certification requirement to granting privileges, while 60% have a continuous board certification requirement in the specialty or primary area of practice.

Most hospitals said they have a process to consider special circumstances or a waiver process, e.g. the flexibility to accommodate an internationally acclaimed physician not trained in the U.S. and not considered a board candidate, but who is eligible for membership/privileges based on his expertise.

Survey respondents report that ramifications for physicians who do not comply with board certification requirements include:

• loss of medical staff membership and/or privileges
• automatic resignation/termination
• suspension

Of those surveyed, 36% would allow a waiver for board recertification in special circumstances, and 72% currently do not have a specific timeframe when an expired board certification must be recertified.

It was reported in the survey that that failure to attain recertification with the appropriate board could result in

• denial of reappointment
• possible loss of privileges
• automatic resignation

As health delivery systems struggle to achieve "best practice" status regarding board certification, several questions get considerable debate: 

1. Does board certification correlate to quality patient care? 
2. Why would a healthcare facility terminate a physician who is considered highly qualified merely because he or she failed a recertification exam? 
3. Are hospitals willing to lose high-volume admitting physicians? 
4. Are all physicians being treated fairly when some "grandfathered" physicians are not required to become board certified?
5. How can a hospital appropriately evaluate those physicians whose board certifications are for "lifetime" versus those who must recertify every 10 years? 
6. Does the value of board certification get cloudy when there are so many inconsistencies?

Current trends show a change in focus from a recertification exam every 10 years to ongoing maintenance of certification as a more appropriate method of measuring competency.  In addition, healthcare delivery systems are beginning to investigate equivalency for international boards that have been previously problematic to compare.

A full summary of the results prepared by Laura Greer, senior association associate in the NAMSS Executive Office, will be posted on the NAMSS.org Web site.

Carole is the Director of the Credentialing Department at Saint Joseph Mercy Health System, Ann Arbor, MI.

Remember, credentialing has no other master than the patient.

That's all for this week.

All the best,
Sally J. Pelletier, CPMSM, CPCS

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