Monday, January 30, 2017

4 Key Healthcare Issues Affecting Credentialing and Privileging to Keep On the Radar Screen for 2017




As we move into the new year, the healthcare landscape continues to force directional changes affecting how medical staff professionals approach credentialing and privileging. Here are four key issues to watch in the coming months:

Issue #1 -  Continued Expansion of Telemedicine


Medical staff professionals (MSP) will continue to face credentialing and privileging challenges with regards to “distant-site” hospitals and the expansion of telemedicine.

Under the Center for Medicare and Medicaid Services (CMS) regulations (42 CFR. Part 482 and Part
485, Subpart F respectively), telemedicine services must be provided under a written agreement
between a hospital or critical access hospital (CAH). The written agreement must contain provisions requiring the distant-site hospital or telemedicine entity to use a credentialing and privileging process that at least meets the Medicare standards that hospitals have traditionally been required to use.

The written agreement must also ensure that the distant-site hospital or telemedicine entity has granted privileges to the individual telemedicine physicians and practitioners providing telemedicine services to hospital/CAH patients, and that the distant-site telemedicine physicians or practitioners hold a license issued or recognized by the State where the hospital or CAH is located. However, if a hospital wishes to utilize the optional credentialing by proxy process, additional requirements must be met.

The continued growth of telemedicine and its subsequent providers continues to generate questions on how to standardize the process. Grey areas include content and delineation of telemedicine clinical privileges and state law including specific considerations such as licensing and prescribing.

Issue #2 - The Transformation of a Traditional Medical Staff Service Department into a Credentials Verification Organization (CVO)


More medical staff leaders and hospital administrators are pushing to streamline the application process and use information provided by the provider for multiple purposes. In the past the application process was the means to verify and approve practicing credentials as well as establish clinical privileges. Now this very same application information is being used for general employment purposes by HR and also managed care organizations (MCO).

Managed care organizations such as health maintenance organizations (HMOs), preferred provider organizations (PPOs) and physician/hospital organizations (PHOs) select and retain qualified health care providers to provide quality services to their subscribers. Laws, regulations, and accreditation standards increasingly require MCOs to carry out the same level of credentialing that hospitals have long been required to carry out. Because MCOs typically handle many more applicants than most hospitals, the credentialing process must be done quickly and inexpensively. Many MCOs have found themselves changing the way in which they do credentialing in order to respond to the demands of the constant changes in the health care industry.

Issue #3 - The Increasing Presence of Advanced Practice Professionals (APPs)


An increasing number of physicians are employing APPs, such as physician assistants, and advanced practice registered nurses, for clinical assistance in the inpatient care setting. Changing state-specific laws, rules, and regulations continue to generate issues for MSPs. APPs often have a wide range of clinical scopes, the licensing requirements are sometimes unclear and vary from state to state, and accreditation standards are continuously changing.  Other types of non-physician providers (e.g., pharmacists, dietitians, etc.) seeking clinical privileges are also increasing.

Issue #4 - Exchange of Information


Information-sharing challenges stay in the forefront as more departments within a health system and collaborators from beyond it, demand increased transparency and or access to privileged peer review information. But, there are guidelines for disclosing and sharing confidential peer review information to consider such as:

  • Maintaining confidentiality of what is being disclosed to third party
  • Disclosing information in a manner that affords liability protections or immunity for the disclosure
  • Focusing on factual information that can be verified in a peer review file
  • Having a policy with guidelines for responding


2017 is set to be another tumultuous year for healthcare. Make sure you and your team are well positioned to deal with more changes and in understanding how these key issues can affect your credentialing and privileging processes.

For more information about how to establish best practices for your Credentialing and Privileging processes go to www.echo-solutions.com or click here for a free consultation.

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