A patient wakes up in the hospital after undergoing brain surgery to discover that she can't feel or move her right foot. Going in, she knew surgery of this magnitude could possibly result in complications, but she finds this scenario particularly worrisome because she was scheduled to have the operation on the right side of her brain, not the left.
To make matters worse, the physician who performed the ill-fated surgery is amazingly able to escape any disciplinary action because she simply surrendered her license in that particular state and moved her practice to another. Incredibly, similar events happen again.
It gets worse. The surgeon in question, now facing new malpractice lawsuits in the state to which she moved, relocates yet again under the same circumstances and is now practicing (one could assume less than spectacularly) in a third geographic locale.
While this (actual) case may be extreme, it is by no means isolated. At leading hospitals all across the country, where quality patient care is of the utmost concern, administrators often struggle with the task of effectively credentialing prospective physicians.
There are two main reasons for this: first, medical board rules and requirements vary from state to state, making it extremely difficult to hold physician applicants from different parts of the country to a single set of credentialing standards; second, appropriate credentialing and privileging training has been insufficient on the whole, due largely to a lack of appropriate hospital personnel and resources.
There are logical steps hospitals can take, however, to prevent a potentially devastating scenario like the aforementioned from taking place. Following are five key considerations for physician credentialing and privileging success.
It's all about process. It should go without saying that no practitioner should be allowed to provide patient care until he or she has successfully satisfied the requirements of a stringent qualification, or disqualification, process. Begin by collecting the appropriate information (i.e., formal education, training and certification.) Then verify that information through primary sources to ensure that what the practitioner provided is valid.
There's no place for complacency. Since the ultimate goal of any provider is to deliver the best patient care possible, healthcare organizations must take whatever steps necessary to develop a sound credentialing and privileging process and to revisit and reevaluate that process regularly to ensure optimal results. Screening incoming physicians and assigning appropriate privileges can be a time-consuming task even under the best circumstances. The more streamlined your processes are, the sooner you'll have the appropriate physicians caring for patients whose conditions fall within their specialties.
Think, and look, outside the box. When you're evaluating a credentials file, having all the appropriate documents is important, but it doesn't necessarily give you the whole picture. Sometimes what isn't included in a physician's background document is as important as what is included, and it often takes a highly trained credentialing expert to pick up on what could be important nuances in an applicant's file.
Appropriate, highly trained personnel are vital. Lack of credentialing and privileging success is almost always due to improper/incomplete training or insufficient personnel and resources. Sadly, incomplete or erroneous processes or decisions based on incorrect information (and the resulting faulty certification of physicians) can easily compromise patient care. It's imperative that your organization takes the appropriate steps to avoid risk by having the right, most highly trained staff possible. When that proves difficult due to internal staffing limitations, it may be appropriate to seek outside help from a trusted organization with a long history of credentialing and privileging success.
Get buy in at every level. We're not just talking about properly training credentialing staff either. It’s also hugely important that your physician leaders, committee members, senior management, board members, etc. all understand the complexities of credentialing and privileging and the importance of implementing the processes necessary to get it right. Obtaining their buy in at the beginning will kick off your process improvement initiative on the right foot and improve your chances of success.
For healthcare providers that do get it right, the results are substantial. In addition to avoiding the potential of the situation described at the beginning of this article, they include reduced costs and risks, to both the patient and the institution (look for a future article on compliance risk), quicker performance, enhanced revenue and, most importantly of course, improved patient care.
Sally Pelletier, CPMSM, CPCS, is an advisory consultant and chief credentialing officer for the Greeley Company, a healthcare consulting firm that offers expertise in accreditation, regulatory compliance, physician-hospital alignment, medical staff operations and non-traditional clinical process improvement to hospitals and health system providers. Ms. Pelletier brings more than 20 years of credentialing and privileging experience to her work with medical staff leaders and medical services professionals across the nation.