Credentialing Short Cuts…
How organizations can legitimately
and safely speed up the initial
appointment process without putting
patients – and the healthcare
organization at risk
Presented by
Vicki L. Searcy, CPMSM
Vice President, Consulting Services
Morrisey Associates
Utah Association Medical Staff
Services
August 13, 2010
Presented by
Vicki L. Searcy, CPMSM
Vice President, Consulting Services
Morrisey Associates
(312) 784-5579
vsearcy@morriseyonline.com
We Will Discuss…
• How organizations can legitimately and
safely speed up the initial appointment
process without putting patients – and
the healthcare organization at risk
– Pre-application process
– Application process
• Documents that applicants are required to submit
• How to obtain a complete application
– Verifications
• What to verify and verification methods
– Accelerating the evaluation and decision-making
process
• Elimination of “idle time”
Pre-Application Process
• Historic purpose
– Prior to implementation of National Practitioner Data
Bank
• Process only applicants with real interest in organization
to avoid wasting time and money
• Eliminate processing of applications that do not meet
organization requirements in order to avoid denials
• Current purpose?
– Pre-application vs. intended practice plan
Application Process
• Ask only for information that is
necessary/required and will be used
– Copies of documents? Purpose?
• Licenses
• Diplomas
• Etc.
– CV
• Think about messages that are being sent to
practitioners about the credentialing process
– If applicants are asked to sign documents when they apply
that wouldn’t be necessary unless they were appointed, are
we sending a message that the credentialing process is a
mere formality?
Verifications
The Basics
• The Application – the data collection tool
– Complete professional history
– Request for clinical privileges
– Consent/Release/Attestation
Risk vs. Value vs. ROI
• WHAT GETS VERIFIED?
– We’ve Always Done It
That Way
– Risk Assessment
– Value to the
Organization
– ROI – staff time, wait
time, supplies, etc.
Verified vs. Evaluated
• Verified
– Current Licensure
– Relevant Training
• What is “Relevant”
• What isn’t
– Current Competence
• What is “Current”
Verified vs. Evaluated
• Evaluated – The Joint Commission
requirement
– Licensure
• Challenges to Licensure
– Relevant Training
– Peer/Faculty Recommendations
• Health Status – Ability to Perform
Verified vs. Evaluated
• Evaluated – TJC Requirement
–
Data from Professional Performance,
if available
– NPDB
• Evidence of Unusual Pattern or Excessive
Number of Professional Liability Actions
Resulting in Final Judgment
– Voluntary/Involuntary (licensure,
membership, privileges)
Verified vs. Evaluated
• Verified and Evaluated – Organization
Specific
– Board Certification
– Criminal Background Check
– Claims History
– All Licenses (All states, current/previous)
Gaps
• Joint Commission Standard
– None
• NCQA Standard
– Work History (5 years) – No Primary
Source Verification (PSV)
– Gap - >6 month to 1 year (verbal/written)
– Gap - > 1 year (written)
Hospital Affiliations vs. Peer References
• Regulatory Standard Requirements
Related to Verification of Healthcare
Organization Affiliations
• Hospital Affiliation Letter
–
–
–
–
–
–
Name
Dates of Affiliation
Current Status
Specialty
Privileges
Quality? – Competence?
Hospital Affiliations vs. Peer References
• Peer Reference/Recommendation
– Peer
– “Current” Competency Evaluation
• Medical Clinical Knowledge, Technical Skills,
Clinical Judgment, Interpersonal Skills,
Communication Skills, Professionalism
Hospital Affiliations vs. Peer References
• Peer Reference/Recommendation
– Department Chair
– Medical Staff President/ VPMA/ Quality Chair
– Training Director
– Friends/Family???
Risk vs. Value vs. ROI
• Peer References (How Many)
• Gaps (How Long – How Far Back)
• Hospital Affiliations (Current – Previous How Far Back)
• Claims History (How Far Back – Where
do you get it)
• All Current and Previous Licenses
Summary
• Review Current Practices
• Meet the requirements
• When your organization decides to
exceed requirements make sure that
there is a return on investment
• Red Flags may precipitate verification of
additional information
Accelerating the Evaluation Process
• Elimination of “idle time”
– How much time is spent waiting for Department Chairs
to review a file, the Credentials Committee meeting, the
MEC meeting, etc.?
– Is there a way to act more expeditiously on files that
are determined to be “problem-free?”
– Does the Medical Executive Committee always need to
meet in person to take action on “problem-free”
credentialing decisions? Can they “meet” more often
than once a month?
Accelerating the Evaluation Process
• Temporary Privileges Pending
Appointment
– Joint Commission sets the rules
• Accelerated Credentialing
– Organization-specific rules
• Expedited Credentialing
– Joint Commission allows the Board to
have an expedited decision-making
process
In Conclusion…
• Critically evaluate:
– How you make applications and privilege
delineation forms available to applicants
• Online applications and privileging is faster and has other
benefits
– Critically evaluate what is being verified
vs. what is required and how the nonrequired verifications benefit your
organization by assisting in making better
decisions
– Eliminate wasted time from the
evaluation and decision-making process
– Streamline whenever possible and
practical
Q&A