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HOW TO NAVIGATE WORK HISTORY DATA FOR CREDENTIALING

July 6, 2020

KEYS TO UNDERSTANDING OBJECTIVE DATA; AND SUBJECTIVE DATA REQUIRING ASSESSMENT

This blog is about the two types of work history data included in an application for employment in health care. Objective data doesn’t require evaluation or assessment. It either is included with the application, or it is not. If any of the required objective data is missing or consciously excluded, the application process is simply terminated.

The type of data requiring assessment is subjective in nature and in the case of work history, is sometimes selectively edited by the applicant. Relying on attestation alone can leave a health care organization exposed to liability, loss of reputation, fines, and civil monetary penalties.

Adding additional data sets to screen and monitor against will fill those data gaps. If a provider omits a stint at a hospital where he was fired for sexual abuse, checking that provider’s name against a national abuse registry may reveal the information that was intentionally withheld. Any subjective data regarding hiring and termination decisions are best backed by rigorous documentation in alignment with the rules, regulations, and bylaws of the organization. 

By Hugh Greeley, author of Hugh’s Credentialing Digest

Work history data for provider credentialing can be difficult to find and verify. This blog is directed to those readers who are responsible for both gathering and assessing health care applicants’ background and work history information as part of the hiring and credentialing of providers. Everyone involved in credentialing recognizes that there are two types of inputs in the application and credentialing process: objective requirements, and subjective information requiring assessment.

OBJECTIVE WORK HISTORY DATA FOR CREDENTIALING

Objective work history data requirements are relatively easy to collect and verify. The absence of objective work history data generally results in termination of the application process without ever reaching the need for denial. Objective requirements generally include but are not limited to the following:

  1. Completion of relevant professional education (medical, osteopathic, podiatry, etc.)
  2. Completion of residency and license
  3. Absence from state and the Office of Inspector General’s (OIG) federal exclusions list
  4. Malpractice insurance
  5. Board certification, or admissibility
  6. Payment of an application fee
  7. Freedom from significant conflict of interest

In the event an applicant fails one of these objective requirements, the application is filed as incomplete and the process simply is terminated.

WORK HISTORY DATA REQUIRING ASSESSMENT

Work history data for credentialing requiring assessment may include but is not limited to:

  1. Sanctions of any type
  2. Professional references
  3. Background (work history)
  4. Clinical experience
  5. Continuing Medical Education (CME)
  6. Number and type of malpractice claims
  7. Prior criminal activity
  8. Health status, etc.

This type of work history data requires analysis by peers in order to determine whether the applicant is to be considered for appointment, employment, privileges, or a contract.

Of the above items, collection and verification of work history data for credentialing is undoubtedly the most complex part of onboarding a provider and is becoming even more so. It is common for providers to choose to practice in many different types of non-hospital organizations, such as surgical centers, urgent care centers, or other ambulatory care facilities. In other cases, a provider will choose to practice as a locum tenens physician, or in a telemedicine setting. It is not unusual for some physicians to have more than 50 current, and work history affiliations listed on their applications or accompanying submissions.

WHAT TO DO WHEN WORK HISTORY DATA FOR CREDENTIALING IS ELUSIVE

What is a Medical Staff Services Professional (MSP) or Human Resources (HR) professional to do when it is impossible to find and verify all of the work history data when hiring and credentialing a health care provider? Must each and every prior work experience be verified? How will you ferret out the applicant who fails to disclose one of five staff positions held in metropolitan Chicago? Is it possible to detect the surgical center affiliation that was omitted from the work history portion of the application? How will an organization verify the dates of a private ambulatory practice of a physician who did not admit or treat at a hospital?

WHEN IN DOUBT, REFER TO PROFESSIONAL REFERENCES

The answer may be that, in some cases, it is functionally impossible to nail down and verify a provider’s complete work history data profile. For that reason, such verification is not always required or necessary. Professional references received from individuals familiar with the applicant’s current and most recent work performance and behavior provide significant information for a committee or medical director to inform a decision.

However, the onboarding and credentialing professionals continue to dedicate resources in an attempt to verify the full work history data profile of each and every applicant. Perhaps it is time to recognize that in these days of expanding ways to practice medicine, it may be impossible to identify the applicant who chooses to hide or simply forgets to include all work history data

Rather than focus on tracking down the full work history profile of every provider, checking other primary source data sets can provide the transparency needed to protect an organization and its patients from underqualified, violent, or fraudulent providers.

HOW WOULD YOUR ORGANIZATION IDENTIFY RELEVANT WORK HISTORY INFORMATION IN THE FOLLOWING CASES?

  • A physician with a past practice history in a large metropolitan area where he/she maintained appointments on multiple staffs. When completing the application for appointment, one affiliation is omitted due to problems the applicant had at that facility that was disturbing in nature yet did not rise to the level of corrective action.
  • The applicant who, after a stressful period in life chose to take a sabbatical for a prolonged period of time and does not believe this fact is relevant when completing the application. He did not resign his membership during this sabbatical.
  • The applicant who has had (or continues to have) a problem with drugs or alcohol and took time out of clinical practice to attend an in-patient treatment program but does not disclose this “affiliation” on the application.
  • The applicant who required participation in multiple residency programs in order to complete his/her general surgery program and chooses to list only the last residency on the application.
  • The applicant who completed residency more than 25 years ago and is applying as a locum tenens after many years in private practice.
  • The telemedicine physician who has 53 current hospital affiliations.

If your answer is “current professional references,” you are on the right track, for such references are a solid way to backstop prior work experience or prior affiliations.

Click here for a downloadable PDF that lists Objective vs. Subjective Application Data.

Verisys Connect is Verisys’ self-service data search portal that provides real-time data solutions to address background information searches.

Data Insights for Health Care Best Practice outlines data sources and how augmenting attestation with these data sources reveals the 360-degree view of a provider.

Also, the e-book, “Closing the Five Critical Gaps in Health Care Screening, Verification and Monitoring for Credentialing” reveals the data solutions that close the data gaps in the six cases listed in this blog.

Learn about ReferencePro as a fast and reliable background check and employment verification service.

Hugh GreeleyWritten by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant
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