Tips For Creating F and OPPE Processes for Outpatient Psychiatry and Other Specialties

Focused and Ongoing Professional Practice Evaluation for outpatient treatment of specialty medicine requires unique clinical indicators.

In this blog, Hugh Greeley gives guidance to the steps of conducting Focused and Ongoing Professional Practice Evaluation (F and OPPE) for outpatient specialty areas of practice.

Time-Saving Tips for an F and OPPE System

Hugh describes time-saving tips in designing F and OPPE systems. One tip is to group similar clinical areas of practice by privileging criteria and design applicable indicators for use by those conducting and contributing to a providers’ F and OPPE.

Implementing this tip saves the medical staff services department from reinventing the process for each provider applying for privileges, and will simplify the process, and reduce the amount of time required by the medical executive committee (MEC) to approve the requirements, forms, and reports.

The following is contributed by Hugh Greeley, author of Hugh’s Credentialing Digest

This idea for this blog was sparked by a question I received from an RN Quality Specialist at Barton Health in South Lake Tahoe, CA. She asked, “What is the recommendation for OPPE for psychiatry in the outpatient setting only?”

My answer is perhaps longer than necessary to answer this question, but it may serve to demonstrate that both Focused and Ongoing Professional Practice Evaluation (F and OPPE) are not as difficult or time-consuming as many hospitals make them out to be. A department chair or director of ambulatory care should be able to conduct either F or OPPE for an individual practitioner in less than a minute. The hospital staff, however, will find that it is necessary to spend considerably more time than that as they access and display existing data for review by the relevant chair.

Identifying the Unique Clinical Indicators by Specialty

The principles identified below are applicable to any specialty in any setting. The only variable might be the specific type of clinical indicator data that is collected and arrayed. For example, a general surgeon might require returns to the OR, transfusion rate, infection rate, mortalities, etc., while a hospitalist may require mortality rate, infection rate, returns to the unit, transfers to other facilities, etc. (in each case most of these records would have been subject to peer review).

F and OPPE are required for any person to whom clinical privileges have been granted by a hospital board. This applies to both inpatient and ambulatory care privileges. However, it should be noted that only employed physicians require ambulatory privileges.

Independent practitioners are not required to apply or hold such privileges unless they are providing care in a hospital-owned ambulatory care unit of some sort, such as a surgicenter, clinic, gastroenterology lab or freestanding emergency or urgent care setting.

Important Considerations for the Design of F and OPPE Systems

These are perhaps the important considerations to keep in mind as you design your F and OPPE systems:

• Do not make the system overly complex.
• Do make a positive decision to bundle or group like clinical privileges, as this will allow you to have a more realistic and workable F and OPPE process.
• Do not use a laundry list of clinical privileges without the above-mentioned bundling.
• Do obtain department chair input and approval for the F and OPPE indicators. (It is not necessary that such indicators actually be developed by departments; in fact, this is generally a non-starter and should be avoided).
• Do recognize that external surveyors are likely to concentrate on the documentation you have generated about the program. Make sure that the plan, indicators, and forms are all approved by the medical executive committee (MEC) and relevant department chairs. They also will ask for the results of both F and OPPE and will be skeptical if you have never identified any sort of problem or have not used FPPE to further investigate at least a few existing staff members.
• Do recognize that the absence of any negative indicator is probably a positive finding. For example, having no nursing complaints is excellent because nurses are a good source of information about physician performance. No infections, mortalities, or returns to the OR suggests that a general surgeon either is not very busy or has good technique and follows generally recognized guidelines in his or her work. The absence of negative peer results is a demonstration that peers have found work to be of acceptable quality (providing that some records were evaluated).

Recognize that you already have a substantial amount of information about most physicians practicing in either the inpatient or outpatient arena:

• Records completion data and information
• Patient complaints and compliments
• Patient satisfaction evaluations and rates
• Peer opinions (all you need to do is capture them)
• Co-worker opinions [which can be captured using either MBWR (management by walking around) or a brief questionnaire]
• Results of peer review (both positive and negative)
• Data from your ongoing monitoring of drugs, blood, surgical procedures, and sentinel events
• Raw volume data that can be arrayed against granted clinical privileges (This is a very good starting point as it will allow the relevant medical staff leader to determine if competence has been demonstrated in all privilege categories/bundles or cores)
• Incident reports (or the absence of these)
• Concurrent proctoring results
• Focused chart review (of a very small number of records selected to represent the privileges bundle)
• Sentinel events
• Clinical data, such as returns to the OR, readmits or admits post-ambulatory care, infections, complications, suicide attempts, post-ambulatory care ED visits, and those required by and reported to either the Joint Commission or the Centers for Medicare and Medicaid Services
• Reimbursement denial
• Malpractice cases filed
• Reports of ambulatory medical directors or personal knowledge held by the person responsible for completing the F or OPPE report
• Plus, as we often say, “the list goes on”

With all this data and information, F and OPPE should be easy. After all, the purpose is to allow a leader to make a determination that a new or existing practitioner is practicing in all areas of granted clinical privileges in accordance with the generally recognized standard (based upon the data at hand).

The job of the organization is to collect all the above data/information (or simply what you have), recognizing that the absence of an incident, malpractice case, readmit, medication error report, patient, staff or coworker complaint, attempted suicide, or problems identified during chart or peer review is actually positive information. Display it on a form that will allow the relevant medical staff leader to review it quickly and complete an F or OPPE report.

Visualize a performance report containing the following data and information:

This practitioner has treated patients within his privilege bundle/core (i.e., workup, diagnose, manage, using either medications or other therapeutic regimes, patients over the age of 3 presenting with either mental illness, depression, or other behavioral issues). He has seen in excess of 150 patients during his first month providing ambulatory mental health services.

He has:

• Glowing comments heard from co-workers
• Positive references from other physicians
• Very good patient satisfaction (92%)
• No patient complaints
• No staff or peer complaints
• No incident reports
• Positive findings based upon the results of peer review performed through our internal program
• No malpractice cases
• No identified admissions post-ambulatory care (within 2 weeks)
• No suicide attempts by patients
• He uses medications consistent with generally recognized standards (no medication errors, inconsistencies, etc)
• Etc., etc.

Now visualize a department chair completing the following form:

I have reviewed the ongoing performance of _______________.

I have based my review upon (check all that apply; you must consider at least three inputs):

• My personal knowledge of the practitioner
• Discussions with co-workers
• Discussion with peers
• Results of peer review
• Positive evidence of effective and appropriate clinical practice as demonstrated by the absence of significant numbers of clinical incidents
• (readmits, ED visits, medication errors, suicide attempts, etc.)
• Patient satisfaction results
• Review of records
• Proctoring results
• Simulation exercises

Based on my review, I am pleased to report that he has demonstrated his current clinical competence in all areas of his granted privileges.

Or (for a small percentage of practitioners):

Based on my review and knowledge, I cannot report that he has demonstrated competence in all areas of his privileges, specifically ________, _______, and _______. (Additional focused review will be necessary in these areas).

Or (for an extremely small number of practitioners):

Based on my review, I am unable to formulate an opinion about this practitioner.

The MEC will need to look into this practitioner’s competence.

Signed _________________             Dated_________________

This form and the performance report outlined above should be maintained in a permanent file, such as the credentials file or a separate quality improvement file.

Ongoing License Status Monitoring Provides a Critical Data Point

While F and OPPE provide important information about competency, adding continuous monitoring against primary sources such as FACIS®, OFAC, Social Security Death Master File and abuse registries nationwide provides a broader view into a provider’s and additional staff members’ character.

Ongoing monitoring of license status tells the story of competency and character from a factual standpoint that is verified by a primary source. Current and complete verified data on an organization’s providers is key to providing quality care and protecting patients from incompetent providers.

Verisys integrates verification and FACIS search results into a streamlined, real-time data delivery system that can include some or all: SFTP, API, Verisys Connect®, a self-serve look-up tool, and CheckMedic®, a cloud-based integrated provider credentialing platform.

Written by Hugh Greeley Credentialing and Healthcare Industry Expert HG Healthcare Consultant Connect with Hugh