Wednesday, August 23, 2017

Credentialing for Ambulatory Surgery Centers - What You Need to Know

This article is an excerpt from Becker's ASC review, written by Laura Dydra.

Physician recruitment is one of the key growth strategies for Ambulatory Surgery Centers(ASCs).
Surgery centers can either attract physicians to bring cases or new physician investors to boost case volume, and add specialties. Here are a few things to know when credentialing new physicians for your surgery center.

Joint Commission Requirements

The Joint Commission released a tool for surgery centers covering physician credentialing and accreditation updates, here are the major actions to take:

• Define the surgeon's scope of care.
• Identify licensed independent practitioners and make sure they are practicing within state laws and regulations.
• Each licensed independent practitioner should have an identified scope of practice that meets state laws and regulations.
• Define qualifications for licensed independent practitioners to practice at your facility, including education and training as well as board certification.
• Place a formal request for privileges from each practitioner to provide care. The request can be in a letter form, application or documented conversation with the medical director.

Eight Tips for an Efficient Credentialing Process

  • Assign someone at the ASC to keep track of credentialing every clinician at the center. This person can update credentials and license information when necessary and take new physicians through the credentialing process.
  • It takes 60 to 90 days for surgery centers to collect all credentialing material required. ASCs can grant temporary permission for surgeons to perform cases without all credentials in place, but it's prudent to conduct a background check on surgeons first to establish they don't have a higher number of adverse events that could put the center at risk.
  • There are several forms physicians and their offices must fill out to obtain credentials at the ASC. Stress the importance of filling the forms out fully before returning them to the ASC; otherwise, there will be more back-and-forth between the physician's office and ASC, adding time to the process.
  • Keep credentials up-to-date to avoid medico-legal issues. If malpractice occurs and the physician's credentials are outdated, the ASC could run into legal issues.
  • Keep a calendar of the important licensure updates and credentialing dates to track updates throughout the year. There are automated systems available to help with this process and notify administrators 30 days before a physician's license, board certification, certificate of insurance and more expires to allow ample time for renewal.
  • Each state has different requirements for physician credentials, but many follow similar rules to accrediting bodies. Make sure you know the rules for your state and accrediting body so you're prepared when the surveyor arrives.
  • Regularly audit files to ensure there aren't omissions in a physician's credentials. Staff members may initially overlook a mistake or forget to update credentials.

Credentialing Mistakes to Avoid

Here are 10 common credentialing mistakes for surgery centers to avoid:

  1. Not having an appropriate employee who is skilled and knowledgeable in the credentialing role.
  2. Not having a predefined process for application requests.
  3. Not having intuitive and user-friendly credentialing software.
  4. Not updating clinical privilege forms.
  5. Not having completed files before committee action.
  6. Not following regulatory and accreditation standards.
  7. Not following the facility's governance documents.
  8. Not linking quality to appointment of physicians.
  9. Not understanding the approval process. 
  10. Not engaging everyone in credentialing.

Make sure your ambulatory surgery center continues to grow and prosper. Contact us today for a free consultation on your credentialing process.

4 Questions Departmentalized Medical Staffs Should Ask to Keep Negligent Credentialing Claims at Bay

This article was originally published on Health Leaders Media, August 14, 2017.

Most medical staffs today are departmentalized in nature. Where departmentalization exists, a medical staff must take care to involve each department properly in the practitioner vetting process to avoid negligent credentialing landmines. For example, if a medical staff is departmentalized, the department chair (or designee) plays an important role in credentialing. This role may be spelled out in accreditation requirements or applicable regulations and typically makes the department chair one of the first clinical professionals to review a credentials application.

Despite this weighty expectation, department chairs are often given little guidance as to what their review should entail. In all cases, the chair (or possibly a designee) should assess the appropriateness of the applicant’s privilege requests and provide his or her opinion to the credentials committee or medical executive committee (MEC). But there are many other tasks that, depending on the facility, a chair could be asked to undertake when he or she receives an application.

Considerations include the following:

  1. Is the department chair expected to review the file for completeness, or can he or she assume that the medical staff office did this?
  2. Is the department chair expected to know whether the application is consistent with any medical staff development plan or exclusive contracts adopted by the hospital?
  3. Is the department chair supposed to make direct contact with the applicant or with his or her references?
  4. Is it the department chair’s responsibility to obtain more information whenever anyone identifies red flags in an applicant’s file, or should this be done at the direction of the credentials committee?
Medical staffs may answer these questions differently, but regardless of the selected approach, it’s critical to be clear about the extent of the department chair’s role. This is particularly true for medical staffs where the department chair serves a limited term and turns over regularly. It is especially damaging in negligent credentialing lawsuits when a chair states that he or she did not understand the role or thought someone else was doing a task that the credentials committee or MEC believed was the chair’s responsibility.

The duties of the department chair are typically spelled out in the medical staff bylaws or in credentialing policies and procedures. As with all medical staff leaders, adequate training and orientation for department chairs is an investment well worth any cost incurred. The effort can save an institution from large payouts if it loses a negligent credentialing claim because a chair or another medical staff leader did not understand how to do his or her job properly or appreciate the importance of diligence in this work.