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 If malpractice occurs and the physician's credentials are outdated, the ASC could run into legal issues.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.

Wednesday, August 9, 2017

4 Reasons to Conduct and External Peer Review

This article was originally published on the Credentialing Resource Center, July 6, 2017.

Although external peer review of a physician’s competence is seldom required in most organizations, it is nonetheless important to have a policy in place should the need arise. In many hospitals, the service line or department chair, medical staff quality committee (MSQC), or another designated group will make recommendations on the need for external peer review to the medical executive committee (MEC). The policy must also define the circumstances in which external review will occur and state that no practitioner may require the hospital to obtain external peer review if it is not deemed appropriate by the MEC or the board.

Circumstances requiring external peer review may include but are not limited to:


When dealing with the potential for a lawsuit.


When dealing with vague or conflicting recommendations from internal reviewers or medical staff committees. Conclusions from this review will directly impact a practitioner’s medical staff membership or clinical privileges.

Lack of Internal Expertise

When no one on the medical staff has adequate expertise in the specialty under review, when the only practitioners on the medical staff with that expertise are determined to have a conflict of interest regarding the practitioner under review, or when the potential for conflict of interest cannot be appropriately resolved by the MEC or board.

Miscellaneous Issues

When the medical staff needs an expert witness for a fair hearing, for evaluation of a credentials file, or for assistance in developing a benchmark for quality monitoring.

The MEC or governing board may also require external peer review in any circumstances deemed appropriate by either of these bodies.

A policy should also be in place regarding information obtained during an external peer review. If the review was conducted for reasons other than legal concerns or credibility, the report is usually first reviewed by the MSQC or equivalent committee at its next regularly scheduled meeting, unless an expedited process is requested by the MEC or the board. If improvement opportunities are found to exist, they will be handled through the same mechanism as internal peer review unless the issue is already being addressed in the corrective action process.

Peer review policies also indicate that if an external peer review is requested directly by the MEC or the board for legal concerns or credibility, the requesting body determines which committee should conduct an initial review of the report.

Contact us for a free consultation on conducting Peer Reviews or or call us at 1-800-733-8737.

Tuesday, July 18, 2017

Tip: Resist Pressure to Rush-Credential Employed Physicians

This article was originally published on Credentialing Resource Center Daily, June 19, 2017.

Hospital credentialing policies should stress that the processes are the same for all applicants seeking medical staff privileges.

Fundamentally, there should be no difference between how employed practitioners and independent practitioners are credentialed.

Verifying the information and evaluating current clinical competence should be the same regardless of whether the applicant internist is an employed hospitalist or an independent internist opening his or her own office.

In the real world, however, hospitals and health systems are under great pressure to expedite credentialing for the employed physicians coming on board in order to maximize productivity (and thereby generate income for the organization).

Even in the face of this pressure, the credentialing process should take no shortcuts—although having an expedited workflow for clean applicants is still possible.

Likewise, the credentials committee should not wield the credentialing process as a political weapon to slow employed physicians’ entry to the medical staff.

Unfortunately, such an approach can occur in areas where independent physicians feel threatened by the employed group or are upset with hospital administration for pursuing these practitioners.

Your organization’s credentialing policies should stress that the processes are the same for all applicants seeking privileges on the medical staff.

Contact us today for a free consultation on your credentialing process.

Friday, June 30, 2017

Top Five Changes in Credentialing Due to the Increased Numbers of Employed Practitioners in Healthcare Organizations

Guest post by Vicki L. Searcy. Vicki is  Vice President, Client Success Services and Consulting for Morrisey, and Echo. 

All of us who work in healthcare have seen and experienced the many changes that have occurred as a result of the shift of organizations to increasingly employ/contract with practitioners. It is not unusual for an organization to employ/contract with 50% or more of their practitioners. The numbers keep rising and it doesn’t appear that there is a downturn in this trend any time soon.

What impact has this had on the individuals who work in credentialing (and provider enrollment)? Here are the top 5 impacts that I’ve observed:

1. The need to successfully integrate the recruitment/credentialing/enrollment process (i.e., the onboarding) has become acute.

Organizations that want to streamline their onboarding processes must determine processes that can occur concurrently rather than consecutively. There must be a defined time during the recruitment phase/contracting when information is made available to the credentialing department so that the credentialing/privileging process can begin. Each organization also needs to determine when enrollment activities can begin so that when a practitioner is credentialed, there is no big lag time between the credentialing approval date and the date on which services can begin to be provided to patients. This sounds easy – but it obviously isn’t.

Tackling these processes – and determining what can be done concurrently versus what must be completed prior to the next process beginning takes a lot of discussion, willingness to change, some willingness to give up some control and a huge dose of cooperation. However, organizations that have successfully transformed their onboarding process have found it to be well worth the time and effort that it took to get there because of increased practitioner satisfaction and increased revenue.

2. As the numbers of employed/contracted practitioners increase, there are more practitioners for whom enrollment with health plans must be managed.  Additionally, there is also a trend for organizations that employ/contract with practitioners to also manage their credentialing process with organizations outside of the health system.

This item is pretty obvious – as the number of employed/contracted practitioners increases, so will the numbers that need to be enrolled with payers. Additionally, I’m seeing that many of these enrollment or “credentialing” departments are also responsible for facilitating the credentialing process for hospitals/facilities that are not part of the healthcare system. For example, let’s say that we have a group of practitioners that needs to be credentialed at a hospital in the geographic area that is not within the system. Perhaps the hospital provides a service that is not provided by the healthcare system or takes care of specific types of patients. The employed/contracted physicians must be credentialed by the hospital and the “credentialing” department of the health system obtains, facilitates completion of and sends applications, documents, etc. to the hospital so that the physicians can be credentialed there. This adds an additional layer of complexity to the work that someone or some department is providing.

3. Proliferation of files – there is now a big need to clearly identify what information is located in the credentials file vs. the “HR” file.

This is an issue that needs to be tackled by many health systems. I see much duplication between documentation and data collected by the Human Resources department and credentialing. There is usually no need to duplicate documentation in the HR file. This is an issue that can and should be tackled when the onboarding process is analyzed. It will usually require some advice from legal counsel about what goes where. HR files should not contain “peer review” documents – those should be contained in the credentials file. There is no need for both departments to verify licensure, etc. Elimination of duplication of activities will help streamline the onboarding process and will also protect information that should not be discoverable in legal proceedings.

4. There is a need for credentialing departments to find out what a practitioner has been hired to do – because of the impact on the privileges that should/should not be requested.

It is becoming fairly routine in some organizations to provide a privilege delineation to an employed/contracted practitioner – only to return it to him/her and ask that it be resubmitted because the practitioner asked for privileges not covered by the contract or – conversely – didn’t ask for privileges that he/she is expected to provide. This often does not occur until the decision-making process when the privilege delineation is reviewed by someone who is responsible for the services that the applicant will be providing once credentialed – an awkward situation at best that requires rework and can add length to the credentialing process. Organizations need to provide better guidance to the practitioners who are asked to complete privilege delineations or have a process in place to have someone review them immediately upon submission.

5. Finally, employed physicians are likely to work in multiple organizations within a health system. There is a trend within health systems to standardize privileges across the system to help more easily facilitate the ability for practitioners to provide services across the organization.

Standardizing privileges within a health system used to be something that CMO’s and others from the C-suite would talk about wistfully. I’ve had many conversations about this with CMO’s who indicated that they were not willing to expend their political capital on something (like standardizing privileges) that they did not believe could or would be successful. The word is out, however, that this can be successfully achieved and more and more organizations are initiating privileging standardization projects. Is it easy? Not usually – but there are tremendous benefits for organizations that persevere.

We can be certain that credentialing and privileging will continue to evolve and that there will be new and constant challenges that those of us who work in this field will need to tackle. The challenges are one of the reasons why I’m never bored!

To hear more on this topic tune in to our latest webinar.

Friday, June 23, 2017

The War Over Maintenance of Certification Heats Up

Excerpts from Medscape Article  published June 23, 2017

The Growing Anti-MOC Movement

Although many things make doctors angry, only one issue has made them angry enough to join together in a unified effort to demand relief from their medical societies and representatives in state legislatures: mandatory maintenance of certification (MOC), particularly for hospital credentialing and insurance network membership.

Pressing state lawmakers to enact anti-MOC legislation has become a cause célèbre for disparate grassroots doctor organizations that have sprung up from Florida to California. Among them are the National Board of Physicians and Surgeons (NBPAS), American Association of Physicians and Surgeons (AAPS), Practicing Physicians of America (PPA), and the Association of Independent Doctors (AID).

"We have amassed almost 50,000 physicians who are communicating about this on Facebook," claims Westby Fisher, MD, director of cardiac electrophysiology at NorthShore University Health System in Evanston, Illinois. Dr Fisher is a co-founder and treasurer of PPA. Formed this year, PPA is a coalition of grassroots physician groups.

Forces have coalesced into a movement that has been influential in spurring medical societies to propose legislation to ban mandatory MOC requirements by hospitals and insurers in at least 17 states this year.

Formidable MOC Proponents

Seeking to block anti-MOC legislation, say movement leaders, are the American Board of Medical Specialties (ABMS), which sets the standards for physician certification in partnership with 34 member boards, and some hospitals and health insurers operating in a given state.

These pro-MOC forces have mounted lobbying campaigns to convince state legislators that hospitals requiring MOC for physician credentialing and insurers requiring MOC for physician reimbursement and network participation should be permitted to continue in the interest of quality of care and patient safety, say physician-legislators who have sponsored anti-MOC legislation.

"It's a David vs Goliath battle," Dr Fisher says.

But doctors in the anti-MOC movement charge that whereas initial board certification is a legitimate requirement, MOC has evolved into a money-making scheme that forces them to pay re-certification testing fees that are too costly and are required too often.

ABMS has tried to meet the doctors halfway. ABMS Member Boards have adopted several changes that lower the costs, increase the relevance of the process to practice, increase flexibility for meeting the standards, and make the whole process more convenient.

Among the changes ABMS cites are remote proctoring or online assessment and other innovations that eliminate the expense and time cost of the exam; the use of resources to simulate the way physicians practice at the bedside; new testing approaches that are more customized to practice and more formative, to help doctors focus their learning; a focus on clinical judgment and decision-making rather than recall of medical facts; and more convenient access to practice-relevant learning and improvement activities.

However, none of these attempts at appeasement, or anything short of making MOC non-mandatory, is stopping doctors in the anti-MOC movement from seeking legislative relief.

Read more on how individual states are handling this anti-MOC movement.

6 Ways to Quash Privileging Squabbles Among Clinical Staff

This article was originally published on Credentialing Resource Center Daily, June 19, 2017.

The number of privileging disputes occurring in hospitals is growing rapidly. It’s easy to understand why if you examine how medicine has evolved. In the “good old days,” physicians of all specialties had a defined area of turf on the playing field and specialties didn’t cross those boundaries.

Now things are different.

The acrimony that can arise from such disputes often leaves scars and wounds on medical staffs that may not be prepared to deal with the change and conflict associated with this challenge.

The following steps will help your medical staff as it deals with challenges to conventional privileging:

1. Assign responsibility for dispute resolution to a small, very experienced committee. Ideally, the credentials committee or perhaps a medical staff standards committee must be charged with the responsibility of "owning" resolution of all privilege disputes.

2. Research, research, research any and all matters or disputes concerning the granting of clinical privileges. Assign a staff person to research and prepare a full background paper concerning the issue at hand. This step is absolutely critical to effective dispute resolution due to the fact that the committee needs unbiased, objective information concerning the issue in order to dialogue effectively with parties to the dispute.

3. Involve the disputing parties. At the conclusion of the research period, a member of the credentials committee should facilitate a discussion between or among the involved parties in an attempt to solicit a consensus recommendation concerning the amount of education, training and experience necessary for the safe and effective performance of the procedure in question.

If the involved parties decline the invitation to meet, then each party should be requested to advise the credentials committee, based upon their own knowledge and with reference to the research concerning the amount of education, training, and experience they believe is necessary to perform the procedure safely and effectively.

A firm time period should be identified for receipt of their recommendation.

4. Have the credentials committee review recommendations. If a consensus was reached, the job of the credentials committee is to test the consensus recommendation against the following criteria:

  • If a physician with this amount of education, training, and experience were granted privileges at this facility, would we be comfortable referring a friend to the practitioner?
  • If the answer to this question is yes, the credentials committee should proceed to recommend adoption of the rule.
  • If the answer is no, the credentials committee's job is to craft a rule, based upon review of the research and after consideration of the various recommendations that will, in their opinion, serve to ensure safe and effective provision of patient care.
  • It may be necessary to touch base once again with the disputing parties and request that they document their objections to a proposed rule in formal minority reports that can be considered at a later point in the process.

5. Consider the proposed rule by the medical executive committee with subsequent recommendation (if controversial) to the board of directors. It is absolutely vital at this point that the policies and procedures used by the credentials and executive committees preclude procrastination, end runs, serious consideration of "threats," or departmental filibusters.

If such activities are tolerated, it is likely that the dispute will escalate into a battle, if not a war.

6. Codify each of the above steps into a formal policy. This procedure should be used during the development of standards for granting and re-granting of clinical privileges.

Such a policy should be recommended by the credentials committee, executive committee, and approved by the board. Once approved by the board, it should be followed absolutely in the resolution of any dispute concerning the granting of clinical privileges.

For more information on establishing and implementing clinical privileging , contact us today.

Friday, June 16, 2017

Provider Data Action Alliance Starts Work on Roadmap to Improve Accuracy of Healthcare Provider Data

Excerpts from Council for Affordable Quality Healthcare (CAQH) press release.

A cross-section of healthcare leaders has begun work on a wide-ranging effort to improve the accuracy of provider data for both industry stakeholders and patients. Convened by the non-profit alliance CAQH, the Provider Data Action Alliance will develop a roadmap that articulates a vision and actionable strategies for obtaining and sharing better information. Alliance participants represent health, dental and vision plans; provider organizations; health systems; government; and health information exchanges.

Despite the considerable investment by the healthcare industry to attain and manage that data—currently estimated at more than $2 billion annually—inaccurate information is common. For example, a report released earlier this year by the Centers for Medicare & Medicaid Services (CMS) found that 45.1 percent of practice locations listed in on-line provider directories were incorrect.

Alliance participants will develop strategies to address the challenges of ensuring accurate and timely provider information. These include managing data that changes frequently due to practice location moves, retirement or other life events. In most cases, providers must inform a number of health plans and healthcare organizations of each change, a redundant process that adds to the administrative burden for providers. Requirements for data collection vary depending on the stakeholder and state regulations. The need to increase provider engagement in the maintenance process is another key issue and focus of the Alliance.

The Alliance was a result of the 2016 Provider Data Summit, a CAQH-hosted conference where more than 100 industry leaders met to discuss provider data challenges. Attendees reached agreement on the priorities for improving provider data and called for further industry-wide collaboration.

Learn more about the Provider Data Action Alliance at

Thursday, June 15, 2017

Cross-State Licensing Process Now Live in 8 States

Excerpts in this post originally appeared in AMA wire.

The Interstate Medical Licensure Compact (IMLC), an initiative designed to expedite state medical licensure for physicians who wish to practice in multiple states, is now live and accepting applications. Currently, eight of the 19 states in the compact can act as the primary state of licensure and source of verification through the compact. These are Alabama, Idaho, Iowa, Kansas, Mississippi, West Virginia, Wisconsin and Wyoming. Ten states—Arizona, Colorado, Illinois, Minnesota, Nebraska, New Hampshire, Nevada, Pennsylvania, South Dakota and Utah—are still preparing to accept applications for verification and background checks but currently cannot act as the state of principal licensure.

The IMLC will make it easier for experienced physicians with positive practice histories to apply and receive licenses in states they’re not currently licensed in. The IMLC estimates that 80 percent of physicians meet the interstate licensure criteria.

  • The compact is a contract between states designed to promote cooperation and adaptation among states. It operates on several key principles:
  • The practice of medicine is defined as taking place where the patient receives care, meaning that the physician must be licensed in that state and under the jurisdiction of that state’s medical board.
  • The commission, made up of representatives from each adopting state, will enforce rules made to expedite the licensing process. Participating state medical boards will retain regulatory authority.
  • All participation is voluntary for both physicians and states.

The IMLC ensures that the language of the compact is identical in all states that have joined. This will not only make the process more efficient for physicians, but will also help ensure that uniform safety measures are met across states.

In addition to modernizing the licensing process, organizations such as the AMA that support the IMLC hope that making it easier for physicians to practice across state lines will increase access to care for patients in underserved areas.

What does this mean for provider credentialing?

The primary areas this new initiative affects are primary source verification and sanctions monitoring. To ensure that you are properly monitoring current licenses and any sanctions or disciplinary actions, you will need to check not only the current state your facility resides in and where the provider is practicing, but also have a process in place to check across state lines.

Your process should offer real time verification and monitoring rather than waiting weeks or months to have your provider data updated, and you should make sure that you are collecting all relevant state data.

Contact Us to discuss your primary source verification and sanctions monitoring processes to see if you need to upgrade.

Friday, May 19, 2017

(Video) Be a Super Hero - Accelerate Turnaround Time for Provider Professional Reference Checks

Professional references are a key component to the credentialing effort as they offer the opportunity to attest to the current clinical competency on any provider making initial appointment, and or at the time of reappointment if new clinical privileges are requested.

The Joint Commission standards require a professional reference to address these six separate competencies:

  • Medical/Clinical Knowledge
  • Technical and Clinical Skills
  • Clinical Judgment
  • Interpersonal Skills
  • Communications Skills

Professional references often include reference letter(s), or written documentation (questionnaires) about the applicant from a peer (practitioner in the same professional discipline as the applicant) who has personal knowledge of the applicant.

Are you faxing your questionnaires or sending PDFs of the questionnaires to referencing providers in a email and asking them to send back their responses? How long does it take you to contact professional references for your providers and to get information back? Days? Weeks? How much time are you spending following up with these providers?

There is a better way! Accelerate turnaround time of reference questionnaires with Echo Survey.

Click here to learn more about how you can speed up your provider reference survey process or call us at 1-800-733-8737.

Tuesday, May 16, 2017

Are You A Provider Enrollment Specialist? We Need Your Input!

Traditionally, hospitals, healthcare organizations, and medical groups have viewed provider enrollment in health plans as a back-office function, lacking strategic importance. More recently however, a number of changes in the industry have caused this function to be viewed in a much more important light.

#1 - Hospitals, healthcare organizations, and large medical groups have employed providers in record numbers, taking on the responsibility of their credentialing and provider enrollment.

#2 - Credentialing and enrollment processes are woefully inefficient in light of current volumes and reporting demands.

#3 - Hospitals, healthcare organizations, and medical groups are actively seeking solutions that will improve efficiency and revenue cycle management.

Against this backdrop, for the past two years we have embarked on examining the current and changing environment for provider enrollment and the implications it has for hospitals, healthcare organizations, and medical groups. Collecting input from provider enrollment specialists like you to benchmark industry data and showcase important industry trends that affect your profession.

Once again, we are preparing our 2017 report on provider enrollment and can use your help. If you are a provider enrollment specialist with a hospital, healthcare organization or medical group, please take a few minutes to help us understand your role and the changes affecting provider enrollment within your organization.

Tuesday, May 9, 2017

(Video) - How to Automate Provider "Good Standing" Requests

In a survey conducted with 915 National Association of Medical Staff Services (NAMSS) members, only 19.5% have fully and successfully implemented automation to reduce credentialing and  re-credentialing time frames.

One of the less automated functions being conducted is third party verification requests. Our research shows, that medical staff offices are spending too much time manually responding to third party requests for provider in “good standing” information.  

Is this happening at your facility? How much time are you spending on this activity?

Watch our latest video "How to Automate Provider "Good Standing" Requests to learn how Echo's 3rd Party Verification Portal can free up staff time for those higher priority tasks.

Why not get started today in eliminating those extra emails and phone calls. Contact us to learn more. Please mention 3rd Party Verification Portal with your request.

Monday, May 1, 2017

Ten Years of Ongoing Professional Practice Evaluation (OPPE) - What Have We Learned?

Guest Post By: Vicki Searcy, Vice President, Consulting Services, Morrisey, a HealthStream Company

The Joint Commission announced the requirement for OPPE in 2007, in order to give organizations time to formulate their strategies for compliance by January 1, 2008 (the date on which OPPE requirements became effective).  We are now in our 10th year of being required to have an OPPE process in place.

What have we learned during the last 10 years?

1. OPPE is a component of privileging.  The reason requiring OPPE is to compel organizations to use data to evaluate practitioner competency specifically related to the exercise of clinical privileges.

2. Performance reports must be focused on the privileges that are granted - therefore, they must be specialty-specific.

3. More comprehensive clinical activity reports are necessary in order to evaluate a practitioner's activity within an organization.  It is insufficient to just identify numbers of admissions/discharges, consultations and total number of procedures.  This does not meet Joint Commission requirements.  It is necessary to collect numbers on the types of procedures performed, etc.  Matching procedures performed to privileges granted is essential.

4. The definition of competency has forever been expanded to include more than technical expertise.  We now include other factors in evaluation of competency - such as professionalism, interpersonal and communication skills, etc.  Organizations are now incorporating information about a practitioner's ability to work well with all caregivers and communication with patients into OPPE reports.

5. Organizations are better served to start small and build on a solid foundation rather than to try to include too much data on reports.  A Joint Commission finding has been that some organizations put a robust policy and procedure in place and then are unable to meet their own requirements.

6. Collaboration from the Medical Staff Office and Quality Management Department is essential to support the process of implementation of meaningful performance reports.

7. Organizations either need to establish thresholds or targets - or analyze each and every performance report in order to identify data that is out of the norm.  It is much less work in the long run to establish targets.

8. OPPE is applicable to any practitioner granted clinical privileges, including physician assistants and advanced practice registered nurses.  OPPE data can be difficult - but not impossible - to collect for these practitioners.  In many cases, data is difficult to collect because of how the organization decided to implement the electronic patient record (i.e., defaults to attending/admitting practitioner rather than to the practitioner - such as a nurse practitioner - who provided the care/service).

9. Sometimes it is not feasible to attribute data to a specific practitioner - the data is more relevant to a team or group.  Astute organizations are working to develop and use team data.  This is also relevant to some privileges that are team procedures rather than a practitioner-specific privilege.  Stay tuned for more information as this continues to evolve.

10. An indicator data dictionary is needed in order to define each indicator that is used in OPPE reports.  For example - an indicator such as "unexpected death" must be defined so that all users/participants in the process of OPPE would know what data would be consistently included.

11. Most organizations are sharing performance information with their practitioners.  In order for practitioners to improve performance, they need to know how their performance varies from their peers.

12. Organizations that contract/employ practitioners want to use the same reports for performance evaluations for "HR" and privileging/OPPE.  This dual usage requires that great care be taken related to how reports are generated, used and maintained to avoid discoverability issues.

Many more lessons have been learned during the past 10 years - and it is certain that organizations will continue to learn how to conduct effective practitioner performance evaluation.

I'd love to hear from organizations that have OPPE success stories to share.

Wednesday, April 19, 2017

Credentialing Made Easier for Medicaid Providers in Texas

This article was originally posted on Texas Dentists for Medicaid Reform

New Legislation

In Texas, private health plans or managed care organizations (MCOs) manage the Medicaid program for the State. The State began transitioning to this approach, called the managed care model, in recent years as an alternative to the former costly and inefficient fee-for-service (FFS) model. The managed care private-market approach drives innovation through flexibility and competition, reduces health care costs, and holds Medicaid health plans accountable for providing access to quality care. It has saved the State and Texas taxpayers $4 billion over a six-year period and is expected to save another $3 billion or more by 2018.

Through this process, MCOs gather and assess background information on health care providers in an effort to confirm the provider is in good standing, ensure patient safety, and prevent fraud, waste and abuse. As it stands, each MCO gathers this background information from providers separately and with varying deadlines, requiring providers to submit and re-submit their information to all 20 Medicaid health plans individually and at different times.

Recently, Texas Medicaid health plans brainstormed on how to simplify this process for physicians and providers and make Medicaid a more welcoming program for quality providers to participate in and provide care to Texas patients. The health plans proposed a statewide CVO concept, which was endorsed during the 84th Texas Legislature in SB 200. The bill establishes a way for Texas to streamline the Medicaid provider credentialing process.

How Does The New Process Work?  

First, there will be a single source for all credentialing information. That means that if a physician or provider in an area of the state wishes to participate in the network of several health plans in that area then the provider information need only be collected once and is then shared with all of the plans.

Second, the Texas Medicaid health plans elected to adopt a single re-credentialing date. That means that when a physician must be re-credentialed, generally a process that occurs every three years, the doctor will be re-credentialed once for all of the participating plans.

The project implementation will begin immediately with  statewide operations expected to begin October 2017.

Monday, April 10, 2017

(Podcast) How Will MIPS and MACRA Affect Patient Satisfaction?

Join our host, Brad Weeks, Director of Performance Improvement and Research at HealthStream, as we share insights from some of the most respected leaders and experts in the healthcare industry.

In Episode 1, Brad interviews Dr. Miles Snowden, the Chief Medical Officer at TeamHealth. Dr. Snowden shares his personal insight on the Medicare Access and CHIP Reauthorization Act (MACRA), and what it means for physicians, hospitals, and consumers.

Below is a short excerpt from the recording with HealthStream’s Brad Weeks, our host:


What do you see as the impact [of MIPS and MACRA] on the patient experience…?

Dr. Snowden:

I am not at all certain that patient satisfaction with care will be improved. And, I think there is a reasonable argument to be made that satisfaction may diminish a bit under MIPS and MACRA. The quality metrics are very narrow, and they result in a very narrow focus. Patients like a very holistic engagement with their physician, a sense of taking care of the whole person or the whole family or the whole home. And these quality measures are not developed with a holistic approach nor could they be frankly at this point in time because how do you report them, in scale, at scale? So the narrowness of the quality measures are inconsistent with the holistic relationship that patients seek for full satisfaction.

So I don't think patient satisfaction will be improved, and it may be diminished, as a result of MIPS. On the other hand, most physicians will tell you some of the least satisfied patients have the best clinical outcomes and vice versa. And that probably holds true here as well. So while patient satisfaction probably won't be significantly improved under the program, clinical outcomes particularly longer term clinical outcomes, I suspect, will be improved.
For the next two or three years, there aren't going to be many patients that are thankful for the promulgation of the final rule for MACRA. Over the next decade or so, I think people will be able to point back and say, "Outcomes, particularly amongst chronic illnesses, did get impacted favorably."


We’ve talked a lot about potentially dire consequences to MIPS reporting and MACRA. What’s the upside?

Dr. Snowden:

It's easy to take a glass half empty approach to MIPS and MACRA, as a physician myself who is in the latter half rather than the first half of my career. I don't feel that way, and I don't see that amongst the physicians who make up our 19,000 clinicians. I see for the most part physicians who are energized and enthusiastic about their practice. I see physicians who generally are comfortable with the use of EMRs now, who are comfortable with being measured against peers, who are comfortable with being required to improve quality outcomes overtime, who are comfortable with supervising advanced practice clinicians, etc.

The physicians who are vocal about being unhappy with the practice of medicine either recently or certainly will be under the new MIPS burdens are generally those who frankly will be gone, with this change. They are in that half of the physician population in the US, 440,000 or so physicians in little groups, or older physicians who probably will look for opportunities to depart. Now that's not a good thing because of course these are highly experienced physicians, they will be terribly hard to replace. But when you think about the remaining physician workforce, these are younger physicians who never knew what it was like to practice medicine in the 80s and 90s. They don't have the context of the older physician who is bemoaning the loss or the way practice of medicine used to be. If you don't have the context of what the practice of medicine used to be, you don't miss it.

I think we have a generation of physicians who are actually very comfortable with more regulated, more peer comparison based practice of medicine. I like that. I think that having more of a team-based approach to healthcare, more of a collaboration based approach, more of a willingness to accept measurement against peer, is bound to improve the quality of medicine over time. And as we migrate to a generation of physicians who are comfortable with technology and EMRs and don't know how to use a pen on a paper chart, we'll see that general group satisfaction rise. And with that, outcomes and patient satisfaction should rise similarly.

Listen to the full podcast here.

Friday, March 31, 2017

Pushing Provider Data Management To The Next Level

An Interview with BJC Healthcare’s Christy Treacy, Director, Provider Data Management Center Team 

Article was first Published in Provider Advisor Magazine, Winter 2017

About BJC 

BJC HealthCare is one of the largest nonprofit healthcare organizations in the United States, focused on delivering services to residents primarily in the greater St. Louis, southern Illinois, and mid-Missouri regions. With net revenues of $4.3 billion, BJC serves the healthcare needs of urban, suburban, and rural communities and includes 15 hospitals and multiple community health locations, 27,283 employees, and 3,964 physicians.

BJC stands out among large healthcare organizations in that their data management operations are extremely advanced. In this post Christy Treacy and her team provide a deeper look into their data management system, progress they have made by using a master provider database, and goals for continued program growth.

BJC’s Provider Data Management Center

In 2006, BJC began to use Echo as the source of truth for provider data and information. BJC operates a Centralized Verification Organization (CVO) integrated with the PDMC. The CVO does the credentialing and primary source verification for all active physicians and allied health practitioners, and the PDMC processes referring providers, including residents, fellows, and employed nurses. Treacy leads both the CVO and the PDMC, and she and her team manage the provider information for the entire health system and feed dozens of other systems within BJC. The PDMC staff is currently made up of three analysts and one system administrator, and they are currently tracking more than 41,000 active and referring providers.

Tracy and her team started a single database effort in 2006 in order to have a central repository to house all of their providers’ NPI numbers, as the CVO was collecting this information during the credentialing process. After experiencing success for that purpose, they began to move all of the provider information to be stored into the one location rather than in 15 different entities. Some of the services PDMC offers to the BJC Healthcare system include employed nurses, tracking of residents and fellows, verifying referring providers, upkeep of provider records, licensure expirables and more.

One of the big components that the PDMC has implemented with tremendous success is the ability to feed the hundreds of downstream systems throughout the BJC health system. Typically, large organizations create a separate export map for each of the systems they are feeding downstream, but BJC created one master file to export that contains 98 different data fields (i.e. address, licenses, specialty, demographics, id number, facility ID number, etc.). The export goes to BJC’s interface engine, IIG, which does the manipulation and cross walking to get the data in the appropriate format for the downstream system.

Success of Utilizing a Master Provider Database

When reflecting on the successes of the PDMC, Treacy and her team cite the significant reductions in inaccuracies in data, delayed claims, delays of patient care, duplication of provider information, and increased identity protection. Additionally, they emphasize the significant alleviation of manual work since the creation of the PDMC and the Enterprise Export.

Another success that has gradually come with the implementation of the PDMC is a more efficient process for requesting data. Now an IT ticket must be submitted and approved that has the specific details of what data is needed, why, and how often. This process has eliminated a significant portion of phone calls with questions about obtaining information.

One of the biggest improvements has been with provider satisfaction, due to an easier process and having regularly updated provider information. The ever-increasing requests for information signals to the PDMC that the word is being spread among providers that they are available to help. Treacy comments on the drastic improvement with providers, “Sometimes it seems like something small, but if it’s something our providers need and we can help them with it, it’s nice to be a part of the solution.”

Goals for Future Growth – 24/7

In discussing the future of BJC’s PDMC, Treacy explains her vision to continue to grow the provider master management data set and to eventually become a 24/7 operation. She explains that providers often run into trouble after-hours and on the weekends, and she adds, “With so much activity surrounding this whole concept of provider data, with so many different sources needing access to it, and with how often we are going to have to update it to keep it clean and available, we are envisioning we’ll soon be available twenty-four hours a day, seven days a week.”

Wednesday, March 22, 2017

The Inefficiency of Manual Provider Enrollment - How You Can Start Saving Today

Today’s payer applications are very complex, lengthy, and redundant. The sheer amount of forms to be completed for each provider can be overwhelming and time-consuming for enrollment professionals. A recent New England Journal of Medicine editorial claims that a coordinated national system of credentialing would save providers nearly $1 billion in administrative costs, and further savings could be achieved if processes for establishing payer–provider contracts were also standardized and conducted electronically.

The average healthcare organization processes 4500 enrollment applications annually with at least 18 applications per physician on staff. Provider enrollment professionals tell us that their biggest challenge is the volume and length of enrollment forms. In addition, complexity of the forms and collecting all the necessary provider data create barriers to timely provider enrollment.

Provider enrollment personnel indicate they spend most of their time on initial enrollment and subsequent revalidation of the providers they represent. Unfortunately, most provider enrollment offices receive less than a 2-month notice to begin enrolling a provider prior to his or her start date. The problem with this is that is typically takes 3 to 6 months to complete the enrollment process so it is very likely that the healthcare organization will lose revenue during this onboarding time. Providers will not be allowed to charge patients and receive reimbursement until the enrollment process in complete.

Our research shows that 56% of provider enrollment professionals use some type of software solutions to help automate their processes (ref), but a high number of provider enrollment professionals are still relying on spreadsheets and other manual processes to do the job. Why risk losing significant amounts of time and money from inefficient processes?

Given the new payment reforms that are coming with downward pressure on revenues, upcoming changes in physician reimbursement, revalidation, and many other initiatives, is your hospital, healthcare organization, or medical group ready to thrive in this new environment?

Utilizing a software program that allows you to have access to preformatted payer forms, and direct integration to CAQH, PECOS and other state enrollment sites can save you both time and money. As an example, with an organization of 250 providers and 18 applications per provider to submit, Echo can help you save over $200,000* in annual costs to complete the application process.

Why not get started today in improving the efficiency of your provider enrollment processes. Contact us today to learn how.

Reference - PROVIDER ENROLLMENT: Revenue Cycle Impact and Woeful Inefficiency Make It a High Priority (DecisionHealth – HealthStream 2016 report)

*Will vary by organization

Wednesday, March 15, 2017

Are Your Patient Care Areas Receiving Timely Provider Clinical Privileging Information?

Industry practice is to make information about what practitioners have been granted privileges - and the specific privileges that have been granted – available to patient care providers. When necessary, nurses’ stations, surgery scheduling and other patient care areas need to confirm a practitioner's privileges.  In the past, paper copies of privileges for each practitioner where sent to these patient care areas. Inevitability, these hard copies ended up being filed in big clunky binders.  A common problem that arises is how do you know that this is the most up to date privileging information?

Today, credentialing software exists that easily enables patient care providers to look up privileges electronically. It is the responsibility of the credentialing/privileging department is to make sure that the privileging information is current. When privileges are granted, the provider’s information should be updated so that current privileging data is available.

The responsibility of patient care areas is to access the privileging information as appropriate.  There should be a patient care policy that identifies how privileging information is accessed, when it should be accessed and what a patient care provider should do if it is identified that a practitioner intends to exercise privileges that have not been granted.  All of this should be covered during orientation for new patient care employees and as well as during annual updates.

In addition, it is likely that during and accreditation survey a surveyor will ask a nurse or surgery scheduler to demonstrate the method for accessing privileges and that is how the system will be determined to be effective - or not. Don’t get caught trying to explain the effectiveness of your privileging look up process. Make sure you have a robust system that is updated on a regular basis and tied to your organization’s credentialing system.

Echo’s Provider Privilege Lookup portal can eliminate the time-consuming copying and distribution of paper clinical privilege lists. Share real-time clinical privilege information with others in your organization that need access. Pages can be created with easy-to-use search capabilities (i.e. by physician or privilege). The information displayed is tailored to your exact specifications and may include physician photos, staff status or department.

Don’t get caught in an accreditation nightmare. Click here to learn more about updating access to your clinical privileging information.

Wednesday, March 8, 2017

7 Reasons Why Health System Contact Centers Need an Event Management Solution

Guest Post by Kay Lynn Akers, Director of Client Experience; Echo, A HealthStream Company.

Today healthcare organizations are holding classes, screenings and programs for a wide range of people.  Whether the target audience is the community, patients, employees or providers the expectation is that the events are well managed and often that responsibility falls to the organization’s contact center.

Keeping track of all the courses, their details, enrollees, payments and correspondence is a challenge. Here are 7 reasons why health system contact centers need an event management solution:

Volume - It’s difficult to enroll a large volume of people using pen and paper.  No matter how many staff are involved it’s virtually impossible to keep a good master list of registrants if multiple people are taking names on multiple tracking systems.

Payments - When dealing with payments there are security considerations as well as process.  It’s important to use a solution that is PCI compliant in addition to having other features such as ability to pay for all classes in one transaction, document payments, and produce receipts.

Communications -  Sending out confirmation and reminder emails to event registrants would be an enormous job manually.  Healthcare contact centers need a solution that can automate these important tasks.  Another important communication is event lists or class rosters for the assigned speakers, facilitators and instructors.  Event management systems offer automated rosters and lists that can be emailed to these contacts and organizers starting at the preferred date for that event.

Reporting -  Paper-based event management doesn’t result in easy reporting.  After an event, it’s important to know the total fees collected, number of registrants among other metrics.  Software can generate these reports for classes individually and aggregated.  It’s easy to slice and dice the data for a variety of perspectives when it’s in an event management system.

Transaction Speed -  Looking up a class or program, finding the right date and then getting on the information needed for registration takes time.  Having a system that can quickly pull up the right event and day is essential and saves time.  Plus, if someone has registered previously, verifying their demographic information is going to be much quicker than capturing it all over again which would be necessary with a manual system.

Self-service - Event management systems offering online registration enable target audiences to register at their convenience versus having to work around your staffing hours. It’s a win-win because a higher volume can be managed with fewer team members by offering web enrollments.

Follow-up - In today’s world people expect emails within minutes of registering for an event.  An event management system can automatically send out these confirmations and receipts without human intervention.  They appreciate reminder emails a few days in advance of the event.  After the event send a link to an online survey via email to close the circle of communication.

These are just a few key operational and patient experience reasons health care organizations should use an automated event management process for their program offerings.

Now that you know some of the ways your call center can more efficiently promote and conduct events with the right event management tools, standardizing on these best practices can transform your call center into a patient experience hub. What to learn more? Click here.


Wednesday, March 1, 2017

29% Failure Rate in Patient Experiences

Guest Post by Rick Stier, Vice-President of Marketing; Echo, A HealthStream Company.

This post is an excerpt from an article that appeared in Connections Magazine.

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution: Exit the call center.

Enter the era of thoughtfully deployed patient experiences, beginning with the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preferences, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.

Patient Experience Failure

Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.” That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Incentivized Reduction of Avoidable Readmissions

One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable (source: Provider Advisor 2016 Volume 2, Issue 2, p. 4).

Increasing Physician Burnout

Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year (source: Daniela Drake, The Daily Beast, 2014). Physicians face increasing burdens, including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; and here comes MACRA (Medicare Access and CHIP Reauthorization Act). 
Beginning in 2019 physicians will be reimbursed on various performance metrics such as quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors, physicians must keep up-to-date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Growing Focus on Revenue Cycle Management

The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks must shift from a wholesale to a retail environment where they interact directly with patients on issues such as pricing, billing, and payment. 

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes.

Patient experience contact centers are a timely response to these industry pressures and many others. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.

For more information on patient experience contact centers, click here.

Wednesday, February 22, 2017

Waiting Too Long To Receive Provider Reference Feedback? Close This Credentialing Loop Faster!

If you were to ask any medical staff office what is the most common obstacle of completing a credentialing file, the answer would most likely be obtaining professional references. Obtaining professional references is the most labor-intensive and time-consuming step.

Professional references are a key component to the credentialing effort as they offer the opportunity to attest to the current clinical competency on any provider making initial appointment, and or at the time of reappointment if new clinical privileges are requested.

The Joint Commission standards require a professional reference to address these six separate competencies:

  • Medical/Clinical Knowledge
  • Technical and Clinical Skills
  • Clinical Judgment
  • Interpersonal Skills
  • Communications Skills

Professional references often include reference letter(s), written documentation, or documented phone conversation(s) about the applicant from a peer (practitioner in the same professional discipline as the applicant) who has personal knowledge of the applicant.

Can You Picture This Scenario?

A busy cardiologist who has an office practice, sees patients and multiple hospitals and performs procedures in an ambulatory surgery center, receives a request from a hospital medical staff office to complete a peer reference questionnaire on an applicant. He or she may also be receiving requests about this applicant from other hospitals and healthcare organizations to which the applicant is applying. If the peer knows the applicant well, he or she may take 10 minutes and fill out the questionnaire as soon as it is received. If the request came by e-mail, the office staff will first need to print the questionnaire so the practitioner can fill it out. Getting the information back to the requesting party is very dependent on that busy doctor and his or her staff.

More commonly, reference requests sit on the peer reference’s desk, fax machine, or e-mail inbox, and will require a second request (which just adds to the stack of reference requests the peer receives) or a follow-up phone call from the credentialing professional.

How Can You Speed Up This Process?

A reference verification survey is a time-saving tool to electronically verify professional references. Email notifications are sent to references who can complete the survey at their convenience. Responses are immediately stored securely in the provider record and a verification register is created.

Decrease your professional reference verification turnaround time up to 80% for provider surveys with Echo’s Survey Module. With Survey Module you can:
  • Create any type of survey – get provider feedback, verify competency, track CME learnings, and more 
  • Conduct reference surveys online for faster turnaround; automate follow-up tasks
  • Activate surveys in a few days with our pre-built content
  • Store survey data directly to your credentialing files – no printing, scanning, importing, or manual data entry required
Providing a more “user friendly” method for peer references to respond makes it more likely that the peer reference will respond in a timelier manner and allow your medical staff office to speed up the credentialing process, lessening the chances of repeated follow-ups. 

Click here to learn more about how you can speed up your provider reference survey process or call us at 1-800-733-8737.

Wednesday, February 15, 2017

(Podcast) - SecondOpinions: Thought Leaders Discussing Issues Affecting Healthcare Today and Tomorrow

Join our host, Brad Weeks, Director of Performance Improvement and Research at HealthStream, as we share insights from some of the most respected leaders and experts in the healthcare industry.

This week we are highlighting a podcast discussion with with Dr. Miles Snowden, Chief Medical Officer for Team Health. Dr. Snowden answers questions and gives his insight into MACRA and the effect this transformative healthcare law will have on physician group practices in the future.

Listen as Brad Weeks and Dr. Snowden discuss these questions and more:

Is MACRA a good thing for healthcare?
What’s the immediate impact MACRA will have on physician practices?
What role do hospitals play in this new practice model?
What is the impact to patients and outcomes?

Click here to listen to this very informative podcast.

Wednesday, February 8, 2017

Is Your Provider Privileging Process Complicated? Simplify It!

We are excited to introduce our latest addition to the Echo provider solutions product family, Privilege Content and Criteria Builder™ (PCCB).  The perfect way to simplify your core provider privileging process, saving valuable time and ensuring a robust compliance program.

Home Privileging Screen

Echo has partnered with Morrisey Associates, the industry-leader in privileging library content and criteria development, to provide these key capabilities and more:

No more looking through books or conducting manual research. Our web-based comprehensive privileging content library, provides delineated privileges for over 100 adult and pediatric specialties, including ICD and CPT codes. 

Easily select and assign privileges with our convenient privilege grouping functionality based on specialties and sub-specialties. Other departments can view granted privileges for quick look up and verification.

Seamlessly create and customize privilege forms from Morrisey’s content with an easy to use drag-and-drop interface. Hospitals can use completed forms electronically or in print and import them from the PCCB website directly into our EchoCredentialing platform.

Click here to learn more about our new PCCB product or call us at 1-800-733- 8737.
™Morrisey Associates

Tuesday, February 7, 2017

Credentialing for Medical Students? Maybe Not Such a Bad Idea!

This article,  a physician imposter gains access to 5 Brigham and Women's operating rooms, originally appeared in Becker's Hospital Review. Here is a short excerpt:

A 42-year-old woman dressed in scrubs attended patient rounds and observed operations at Brigham and Women's Hospital in Boston even though she wasn't a physician. The woman first gained access to restricted areas at Brigham and Women's Hospital in September by requesting to shadow a surgeon while her application with the National Resident Matching Program was pending.

A surgeon agreed to let the woman shadow him not knowing she had been dismissed from a surgical residency program at Mount Sinai St. Luke's Hospital in New York City in May and reported to the New York Office of Professional Misconduct. It was also later discovered that the woman forged the three letters of recommendation attached to her application with the National Resident Matching Program, according to the report (See the original article for more details).

How Could This Have Been Prevented?

Well, first of all after reading the article it is clear there were quite a few loopholes in the above scenario; not all credentialing related. But as you dig further into the sequence of events, it seems like a more formal credentialing process for soon-to-be medical residents would have been prudent.

As a medical student, when applying for residency you haven't received your medical degree yet or passed any of your board certifications, so how can any of your credentials be verified? First and foremost a simple background check should be conducted for any potential employee and certainly anyone that is given permission to be in or near "critical" patient areas of the hospital. ID badges, visitor badges or other forms of identification should not be issued unless there is a recent record of this person in the hospital database.

If they are a medical student or in this case have applied for residency, this information should be verified. Prior to applying for a resident match, candidates must go through a interview with the respective hospital. This information should be documented within the specific hospital department, for example, orthopedics. For the National Resident Matching Program, hospitals submit to the organization which candidates they have interviewed and want to train. This information could have easily been verified as part of the background check.

Finally, the New York Office of Professional Misconduct is a state office that "investigates complaints about physicians, physician assistants and specialist assistants and monitors practitioners who are subject to Orders of the State Board for Professional Medical Conduct. This section provides a listing of all physicians, physician assistants, specialist assistants, and professional medical corporations who have been disciplined since 1990, or who are subject to a non-disciplinary Board Order, or upon whom charges of misconduct have been served."

This organization is one of many that can be monitored for sanctions or exclusions against providers, and other healthcare professionals. An ongoing monitoring program for all such employees including soon-to-be residents and fully credentialed medical doctors on staff would have potentially raised a red flag for this imposter.

For more information on background checks for your medical staff or sanctions and exclusions monitoring click here or give us a call at 1-800- 733-8737.