HCPro.com - Credentialing & Verification Update

Editor’s note: New changes to Credentialing and Verification Update

Wed, 11 Mar 2009 21:37:00 GMT

Beginning the week of March 23, Clinical Privilege Update, Clinical Privileging Advisor and Credentialing and Verification Update will merge into a new ezine called Credentialing Resource Center Connection. You will still continue to get news on trends in the field of credentialing and primary source verification you’ve come to expect, but with additional articles and expert analysis on a wide variety of issues central to the field of credentialing and privileging. The first issue of Credentialing Resource Center Connection will arrive in your mailbox on March 27.

Ask the expert: How do you encourage full disclosure on an application?

Wed, 11 Mar 2009 18:54:00 GMT

When it comes to credentialing interrogatories—question on the medical staff application that focus on everything from licensure, registration, and clinical history to malpractice claims and board certification—think about the language that’s being used. Consider whether you want to use the words “every” and “voluntarily” or “involuntarily.” These words will force full disclosure. For example, if someone voluntarily surrendered his license while under review, the applicant might think he or she did not need to disclose that information if the adjective “voluntary” was not specifically included.

Similarly, using the phrase “any jurisdiction” means that the applicant will not just limit the response to state licenses.

Sometimes you don’t want to use the phrase “healthcare organization” because it is too limiting. Adding “professional organization” will force disclosure of information regarding disciplinary actions, etc. by all relevant organization, including membership in professional societies.

The previous text is an excerpt from the HCPro, Inc. book Medical Staff Law, by Anne Roberts, CPMSM, CPCS.

The verifications department at a locum tenens firm

Wed, 11 Mar 2009 18:51:00 GMT

A locum tenens firm’s verification department is integral to verifying the quality of candidates being submitted to healthcare organizations (aka the clients of the locum tenens organization) for their coverage needs. Practitioner candidates working through a locum tenens firm will be endorsed on the firm’s professional liability insurance policy.

To determine if a potential candidate can be approved to practice under the firm’s policy, they are required to complete a verification packet. This packet includes items such as a Release of Authorization form, used when verifying a candidate’s credentials and a malpractice application. This form asks the candidate to give details of their education/training, work history/affiliations, malpractice history and asks the candidate disclosure questions relating to their current and past medical practice history.

To read the complete post about the verifications process at one locum tenens firm, click here to visit the CRC Blog, and scroll down to the post “The verifications department at a locum tenens firm.”

Tip of the week: Educate your credentials committee members

Wed, 11 Mar 2009 18:27:00 GMT

Committee members must have a thorough understanding of what is required of the medical staff and hospital to help keep the credentialing process moving smoothly. Many times the members know that something has to be done, but they don’t have a clear understanding of why or how credentials are verified. Nor are they aware of what documentation is required by accrediting bodies, regulatory agencies, and hospital bylaws. Understanding these issues will lead to a more thorough credentialing and privileging process.

The previous text is an excerpt from the HCPro, Inc. book The Medical Staff Meeting Companion, by Kathy Matzka, CPMSM, CPCS

Editor’s pick: What’s your credentialing software missing?

Wed, 25 Feb 2009 19:56:00 GMT

If your medical staff office’s existing credentialing software helps create and generate credentialing reports but gets a failing grade for compatibility with your privilege forms, don’t start from scratch. Consider a software “add on” that will help you develop, maintain, and disseminate criteria-based core privilege forms that comply with regulations. To learn more, register for a live Webex demonstration of Core Privilege Plus Tuesday, March 10 at 1:00 EST. To register, email Executive Editor Maureen Coler at mcoler@hcpro.com or call 781-639-1872 x3741.

Question of the week: Should the medical staff office track the dates of practitioners’ DEA certificates?

Wed, 25 Feb 2009 19:52:00 GMT

Yes. If the practitioner fails to renew his or her Drug Enforcement Administration (DEA) certificates, he or she can no longer administer or write prescriptions for narcotics. MSPs can implement a pharmaceutical suspension program which notifies the department chair and the pharmacy of the practitioner’s restrictions. For anesthesiologists, however, this would be a full suspension and would fall under the automatic suspension process outlined in your hearing and appeal policy.

The previous text is an excerpt from the HCPro, Inc., book The Credentialing Coordinator’s Handbook, by Anne Roberts, CPMSM, CPCS.

Conflict of interest questions on a credentialing application

Wed, 25 Feb 2009 19:49:00 GMT

Like falling dominoes, it seems that one organization after another is demanding practitioners disclose conflicts of interest these days. Often times, the reasons behind this disclosure desire is that institutions fear their practitioner may be more loyal to pharmaceutical companies or device manufacturers than to patients. Ironically, some experts question how much patients care about their practitioner’s ties to big industry, according to a recent AMNews article “Medical centers reveal doctors’ industry pay.”

Nevertheless, hospitals are obligated to ensure practitioners deliver high quality patient care, not high financial returns for other organizations.

This raises the question: how should hospitals query practitioners about conflicts of interest? One place to put this question is on a credentialing application, but is this the correct place? If your organization does not already have a policy that addresses conflicts of interest disclose, your medical staff may want to form a committee as the first step to creating one. Don’t forget to include hospital legal counsel in these discussions to ensure compliance with applicable laws.

The preceding entry is posted on the Credentialing Resource Center blog. To post a comment, or access the original AMNews article, click here.

Tip of the week: Ensure the credentials committee owns the annual credentialing report

Wed, 25 Feb 2009 19:45:00 GMT

The annual credentialing report (the overview of a facility’s current credentialing process provided for the hospital’s board, risk managers, in-house counsel, and others) should not be owned by the medical staff office or credentialing department; rather, it should come from the credentials committee or other group charged with the responsibility of overseeing credentialing. It is acknowledged that the medical staff office or credentialing department will do most of the preparatory work on the annual report, but the report itself should be viewed as “belonging” to the credentials committee for it to have maximum impact.

The previous text is an excerpt from the HCPro, Inc., book Credentialing Audits: Tools for Compliance and Reduced Liability, by Vicki Searcy, CPMSM.

Tip of the week: When establishing locum tenens’ competence, make sure you go back far enough in time

Tue, 10 Feb 2009 21:20:00 GMT

When credentialing and privileging a locum tenens practitioner, your competency data collection efforts should cover one year of the applicant’s history at a minimum, according to some experts. Keep in mind that your facility’s bylaws may require you to go back even further. And if the reports you receive raise questions about a practitioner, then you should go back as far as you need to acquire sufficient information to determine whether there is a troubling pattern that might affect your privileging decision.

The preceding text is an excerpt from an article that appeared in the January 2008 issue of Credentialing and Peer Review Legal Insider. Click here to read the entire article.

Qualifying for fast-track status

Tue, 10 Feb 2009 21:04:00 GMT

Each organization must develop a fast-track policy that best fits its unique needs. Such a policy should outline the process that the organization will follow to fast-track these applications through the approval process, as well as identify candidates that may not qualify for fast-track processing. These predefined criteria should be set be the credentials committee and approved by the MEC and the board of directors. Commonly, applicants who have a complete and clean application can easily be fast-tracked. The organization, of course, defines what qualifies as clean in its policy. Just a few of the identifiers include:

•   No negative or questionable recommendations
•   No discrepancies in information received from the applicant or references
•   The applicant has completed a normal training/education sequence
•   No reports of disciplinary actions or legal sanctions

The previous text is an excerpt from the HCPro, Inc., book The Credentialing Coordinator’s Handbook, by Anne Roberts, CPMSM, CPCS.

Question of the week: What?s the difference between credentialing and credentials verification?

Tue, 10 Feb 2009 21:00:00 GMT

One point of confusion for many people is the difference between the terms credentialing and credentials verification. Credentials verification—determining whether a practitioner’s credentials are authentic and valid—is only one aspect of the credentialing process. With credentials verification, there is nothing to decide and the results speak for themselves; an applicant has or has not graduated from medical school, has or has not completed a residency, and does or does not have a valid license to practice medicine in a particular state.

The term credentialing, however, refers to the overall process of gathering and verifying credentials information, reviewing that information, and making a decision to grant or deny medical staff membership and the request for clinical privileges.

The previous text is an excerpt from the HCPro, Inc., book The Comprehensive Guide to Credentialing and Privileging for Ambulatory Surgery, by Laura Harrington, RN, BS, MHA, CPHQ; Beverly E. Pybus, CPMSM; Dawn Q. McLane, RN, MSA, CASC, CNOR.

To get other credentialing and privileging news and information, visit our blog at: www.credentialingresourcecenter.com/blog.

Question of the week: What’s the difference between credentialing and credentials verification?

Tue, 10 Feb 2009 21:00:00 GMT

Tip of the week: When establishing locum tenens? competence, make sure you go back far enough in time

Tue, 10 Feb 2009 20:52:00 GMT

Tip of the week: When establishing locum tenens’ competence, make sure you go back far enough in time

Tue, 10 Feb 2009 20:52:00 GMT

Hosptials meeting ER demands with locum tenens physicians

Wed, 28 Jan 2009 15:51:00 GMT

A shortage of primary care physicians and an increasing number of Americans without health insurance are leading to an increase in emergency room patients that hospitals see every year. As a result, many hospitals are turning to locum tenens surgeons to make up for the shortage of general surgeons and emergency physicians needed to staff their ERs. Locum tenens will continue to provide a solution to physician shortages around the country but also provide numerous challenges to medical staff professionals responsible for their credentialing and privileging.

Using information from Google when credentialing medical staff applicants

Wed, 28 Jan 2009 14:35:00 GMT

Without a doubt, Google and other search engines have transformed the way credentialers verify medical staff applicants’ histories. Not only can search engines, including the online Credentialing and Privileging Desktop Reference, help you find a missing medical school fax number, some can also reveal myriad details about a physician’s past personal or professional life. Work-related incidents, personal mishaps, lawsuits, and other facts often turn up in a simple Google search.

Indeed, running a Google query on medical staff applicants should not be skipped in the event it does reveal information not contained on the application. Credentialers should, however, exercise discretion in how they use this information.

Although any disconcerting information discovered about an applicant on a Google search should be treated as a red flag on the application, any information for which the Internet is the sole source should never be considered conclusive or the justification for a denial of privileges or other action.

Free credentialing form: Application for medical staff reappointment

Wed, 28 Jan 2009 14:31:00 GMT

For a limited time, the Credentialing Resource Center (CRC) Blog presents a free credentialing form every Friday that you can download and customize for your organization.

This week’s form is an application for medical staff reappointment submitted by a reader who works at a long-term acute care hospital. The form is already partially filled in to show readers how it functions, and can be customized to meet your medical staff’s needs.

Download the free application for medical staff reappointment form now.

New certification board formed for hospital medicine

Wed, 21 Jan 2009 19:25:00 GMT

There's a new specialty board in town: The American Board of Hospital Medicine (ABHM). Founded this month, the ABHM a member board of the American Board of Physician Specialties (ABPS) and is the nation’s first certification board exclusively dedicated to hospital medicine.

Physician leaders responsible for founding the ABHM include Diplomates from the ABPS, the American Board of Medical Specialties, and the American Osteopathic Association Bureau of Osteopathic Specialists.

Learn more about the ABHM from the ABPS Website.

Voice your opinion on the CRC Blog

Wed, 21 Jan 2009 14:25:00 GMT

As you have probably noticed, many recent issues of Credentialing and Verification Update include selected articles from the Credentialing Resource Center (CRC) Blog. I hope you have enjoyed the information and commentary in these stories, and perhaps clicked through to see what else the CRC Blog has to offer.

Today, I'm excited to announce a new reason to visit the CRC Blog: Everybody can now join in the discussion!

Although leaving comments on the blog was previously reserved for CRC subscribers, the Website now welcomes comments from all readers. There's no subscription or log in required; simply enter your name, email address, and your comment. You can use the comment function to ask the authors questions, offer your opinion, or start a discussion with other readers.

Join the conversation on the CRC Blog now.

From the CRC Blog: Checklists, training, and simulators

Wed, 21 Jan 2009 14:14:00 GMT

Aviation safety and preventing medical errors are topics that usually catch our eye. Rita Schwab’s blog has a great article about lessons learned from Flight 1549 and how comparisons have been drawn between healthcare and aviation in recent years. In discussions about medical error prevention, the question usually comes up about who you trust more: the pilot of the plane you are flying in or your healthcare provider. Chances are the majority will select the pilot.

My husband is a pilot and I know from his description of checklists, recurrent training sessions, and simulator training just how much detail goes into making sure certain procedures become second nature in performance. Although he rarely has had an occasion to take such action while flying, he and his team practice how to ditch a plane, put out engine fires, and land in adverse conditions. Preventing an accident starts with the first readiness step to get the plane in the air.

A recent article in The New York Times, Simple Checklist Makes Surgery Safe, explains that surgical teams are now implementing checklists to reduce surgical complications. What is a primary cause of such errors that can be reduced with a checklist? Communication problems. Before the surgery begins, nurses and physicians are confirming that sterilization procedures have been completed, the patient has been adequately prepared, the surgical site is confirmed, and that appropriate equipment is at hand to handle any medical need (blood, oxygen, etc). This checklist may cause a drop in death and complication rates.

In addition to checklists and training, another recent article recommended creating a curriculum that would address both error prevention and response as well as establish a team of expert first responders who would guide patients and clinicians when medical errors occur. That article is “Guilty, Afraid, and Alone - Struggling with Medical Error,” by Tom Delbanco, MD and Sigall Bell, MD, and it appeared in the New England Journal of Medicine.

Seems like a great approach to aligning aviation safety with healthcare error prevention.

Carole La Pine, MSA, CPMSM, CPCS is the Manager for Physician Services at Trinity Health in Novi, MI. Carole has more than 30 years of experience in the medical staff services profession and is a past president of National Association Medical Staff Services (NAMSS). Read more from Carole at the Credentialing Resource Center Blog.