Credentialing & Privileging

How much information should your organization share?

Credentialing Resource Center Connection, September 13, 2007

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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 department. Starting today, she will be sharing this space with columnist Sally Pelletier. Please join me in welcoming our new columnist!

Dear credentialing colleague:

Recent lawsuits have forced hospitals to take a closer look at the type of information they disclose (or fail to disclose) when they submit responses to hospital affiliation verification letters. Affiliation verification letters ask organizations to verify the dates that a physician was affiliated with the organization, staff status, privileges, and so on. 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 physician had previous formal action taken by the hospital or if there is action pending.

In the case of Kadlec Medical Center v. Lakeview Anesthesia Associates, the court determined that Lakeview Anesthesia Associates (LAA), Lakeview Regional Medical Center (LRMC), and the physicians who completed the peer reference letters had a duty to disclose to Kadlec Medical Center the information surrounding the anesthesiologist's departure (he was terminated from LAA for substance abuse issues). A jury later issued a $4.1 million verdict against the defendants.

The preceding case is a strong example of why hospitals must be very cautious to ensure that when they respond to affiliation verification letters, they disclose the appropriate information. You should always use caution when releasing confidential information to outside organizations and ensure that you read the release of information that the requesting organization submitted to ensure that it specifically releases your organization from liability for providing information in good faith. There have been many times when I review a verification request and realize 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 requesting 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. Your hospital should ensure that the type of information as well as the detail of information you disclose is consistent between providers and per provider. Generally, hospitals should develop and use standard language for each physician that has reportable actions. The hospital's legal counsel should approve this language.

At the time that the practitioner receives the disciplinary action, you should make sure he or she understands that this is something he or she is required to disclose, in accordance with the organization's policies, and that the hospital is also required to disclose the disciplinary action to other entities upon request, according to its own policies. As mentioned earlier, common practice (such as what was used at LRMC) was to use general letters verifying the minimum amount of information. A lot of hospitals still follow this practice, and this information is acceptable if there are no issues related to the practitioner. Ask yourself whether you would accept the information you are sending, or if you would want more detailed information for your credentialing process. You should, however, keep a "practitioners with reportable actions" list on hand to verify that the general statement verification letter is not sent out for practitioners on that list. Instead, you should answer all questions as honestly as possible, in consultation with legal counsel. The Healthcare Quality Improvement Act protects organizations and individuals providing such information as long as they provide it in good faith.

Failure to disclose the information puts your organization at risk for a lawsuit similar to the one outlined earlier.

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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