8 Simple Steps to Expedite and Improve the Provider Credentialing Process
A Brief History of Board and Committee Review Practices for Physician Applicants
This blog by Hugh Greeley covers how the provider applicant review process can be a very slow, arduous one, and suggests 8 key data points that will determine whether to progress a candidate to the chair, board, and credentialing committee, or request further information from the candidate.
This is the most important process, aside from continuous monitoring, that assures the provider population of a health system is qualified to practice in the areas where privileges are granted and are compliant with quality standards and regulatory requirements.
The following is contributed by Hugh Greeley, author of Hugh’s Credentialing Digest
Incomplete Credentialing Files Delay and Confuse the Process
In earlier years, it would not have been unusual for a credentials coordinator or medical staff secretary to gather a stack of new applicants’ credentials files and march off to a meeting of the credentials committee for review. Had there been an observer in the room, he or she might have been surprised when the chair handed individual files to each member for review.
Unprepared members might then have any of the following comments:
- “I can’t find a license. Is this applicant licensed?”
- “I’ve never heard of this medical school. When did we begin training physicians in South Dakota?”
- “I thought we decided that we needed three letters of recommendation and I can only find one. I can’t review this file until it is complete, and I have a case scheduled. I’m out of here.”
- “This residency program is terrible; I know the director there and he could not make it in private practice.”
- “Not another surgeon. We just don’t need anymore. I recommend denial.”
The medical staff secretary would valiantly attempt to answer each question because the chair (also unprepared) could or would not do so:
- “Well, doctor the license is filed in the pocket marked ‘licenses and certificates’ here, let me help you find it.”
- “I don’t know, but it is an approved medical school and Dr. Smith on our staff went there.”
- “I requested three letters of recommendation, but this applicant is joining the ortho group and they have been pressuring me to get this file reviewed. They said they will vouch for the applicant and additional references are not necessary.”
- “The residency program is approved by the ACGME, but if the committee wants more information, I will try to get it.”
- “We have an open staff, and patients have to wait a long time to see a general surgeon. There are no grounds for denial.”
To that, a member of the committee might immediately say, “Jean, you’re not a member of this committee. It takes a physician to evaluate another physician, not a secretary.”
Evolution of the Credentialing Process
We’ve come a long way since those hallowed days. Today, many hospitals understand that a file should not be presented until all objective criteria are met and all subjective material has been received. However, many hospitals continue to present the entire file to members of the committee (either in advance or at a meeting). Some have recognized that busy physicians are not the best and most careful reviewers of such files and have vastly improved the system by creating an administrative summary of each applicant, pointing out the need to review important “attached” material. Such a summary serves many objectives.
Starting with an Administrative Summary Template that Provides Consistent Checkpoints:
- Assures that each file will receive careful attention to that which is important
- Eliminates the need for busy physicians to search for items that are of no consequence to competence and “legal” qualification
- Demonstrates to regulators and surveyors that each file is complete and has been subject to appropriate review
- Confirms the competency of the staff in the medical staff office
- Professionalizes the process, thus permitting expedited review and decision-making
Medical staff directors and vice presidents of medical affairs (VPMAs) could easily craft such a summary for use in the credentials process. A portion of the summary might simply contain evidence that objective requirements are indeed met. Neither fanfare nor lengthy notes would be necessary. What would be needed is simple confirmation that the applicant is licensed, has completed med school, has completed residency, is appropriately certified or is in the process (if required), has insurance, has a valid DEA license, has signed all required forms, has completed the application in its entirety, and has supplied all specially requested material. This section would also become the staff’s checklist of a complete application “ready for review.”
Data Checks that Determine a Pass/Fail for Advancement for Formal Review by Chair, Board, and Committee
The second section of an administrative review could be used to point the department chair or credentials committee to specific documents that require review in order to determine competency and professionalism and to once again demonstrate that the medical staff services office had done its work appropriately.
Items requiring review would be highlighted, while others showing nothing of importance could simply be noted. For example:
- Professional references note no concerns at all, all positive
- No malpractice history
- No criminal convictions
- No federal or state sanctions
- No prior disciplinary action identified
- Clinical experience confirmed in all areas of requested privileges
- No gaps in professional work history
- Health status confirmed by reference (or chair, exam, or other)
Data Findings to Explore before the Formal Review by Chair, Board, and Committee
- Professional references note concerns; see attachment A
- 11 malpractice settlements reported; see attachment B
- One conviction identified; see attachment C
- Licenses revoked in Oklahoma and Illinois; see attachment D
- Clinical privileges restricted by Memorial Medical Center; see attachment E
- Clinical experience was not confirmed in three areas; see attachment F
- 7-month gap in recent practice; see attachment G
- Reports of substance abuse; see attachment H
The application with the questionable data findings would probably never make it to the department chair or credentialing committee. A letter requesting significant additional information about each of the above findings would have been carefully drafted and sent to the applicant. Most likely, you would never hear back from him or her and the application process would simply terminate with no recourse whatsoever.
A FACIS® check provides clarity to most of the critical items that would easily progress a candidate to further formal review or defer the burden on the applicant to produce the needed data without unnecessary administrative attention from the medical staff services department.
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|Written by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant
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