Credentialing: Prepare residents for appointment

Residency Program Insider, September 13, 2005

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Dear residency program colleague:

What do your residents know about the hospital credentialing process? Unfortunately, the answer to this question is often "nothing." However, some programs are tackling this education challenge by ensuring every resident receives a copy of the organization's credentialing manual--along with copies of the medical staff bylaws, fair hearing plan, and hospital's policies and procedures--during orientation.

During residents' third year, many programs are enlisting the help of the hospital's medical services professionals to prepare residents for medical staff membership by explaining credentialing, privileging, and peer review. Below are some common credentialing questions your residents should know the answers to before leaving your program to pursue medical staff appointment.

  1. Why does the credentialing process take so long? The process often takes longer than necessary because the applicant physician has not provided enough information the application, forcing the hospital and medical staff to search for the information. Occasionally credentialing takes longer than necessary because committees do not meet in a timely manner and because too much time is permitted to pass before committees or chairs act on the application. Many medical staffs have taken significant steps to reduce the time necessary for processing an application. However, it is fairly standard for an applicant without "red flags" in his or her application to take between 30 and 120 days to process.

  2. What is primary-source verification and why is it necessary? Hospitals are required to confirm information about the applicant's education, training, competence, license, and history. Hospitals must contact the source that issued the medical degree or diploma to confirm this information, contact the colleagues of the applicant who will attest to the applicant's clinical competence, verify the applicant's physician's license with the state that issued the license, and contact the National Practitioner Data Bank (NPDB). Primary-source verification is required by state law and various accreditation standards, and allows the medical staff and hospital to make decisions based on a complete and accurate picture of the applicant.

  3. How can I request a change in my privileges? Physicians may generally request a change in their privileges by reviewing the procedures in the medical staff bylaws. In most instances, requesting a change in privileges simply requires the physician to complete a form provided by the institution that gathers information necessary to support the change.

  4. Will I be reported to the NPDB if I don't reapply? You will likely not be reported for failure to reapply to the medical staff. The NPDB is interested in information pertaining to physicians found to have professional performance problems. In many instances, physicians choose not to reapply due to relocation or a change in their primary practice location. However, hospitals are required to report to the NPDB any physician who resigns from the medical staff to avoid an investigation that could lead to disciplinary action.

  5. What is my recourse if I am denied appointment, reappointment, or clinical privileges? A physician's options for recourse under these circumstances are detailed in the medical staff bylaws and the institution's fair hearings and appeals policy. Generally, physicians denied appointment, reappointment, or clinical privileges have a right to a fair hearing before a panel of physicians (and sometimes non-physicians) who are relatively disassociated from the credentialing process and who have no economic interest in the applicant's practice area.

That's all for this week!

All the best,

Hugh Greeley
The Greeley Company

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