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Monday memo: Delegated credentialing and authorized agents

TIPHospitals are federally mandated to query the National Practitioner Data Bank (NPDB) when an eligible practitioner applies or reapplies for medical staff appointment or clinical privileges. “A hospital may not delegate its own responsibility to query or credential practitioners because of the federal requirement that hospitals must query. A hospital’s query must be submitted to the NPDB either directly by the hospital or through the hospital’s authorized agent,” the NPDB states.

The differences between delegated credentialing entities and authorized agents can be confusing, but in the September online issue of Data Bank News, the NPDB provides a side-by-side comparison/explanation (as well as the bolded text in each field):

Authorized agent

Delegated credentialing

An entity selects an authorized agent to report and/or query the NPDB on its behalf, without making credentialing decisions. The authorized agent simply performs the assigned tasks. An entity gives another entity the authority to
make final credentialing (i.e., hiring or privi-
leging) decisions, such as when a health plan
uses a hospital’s credentialing decision as the
basis for permitting a practitioner to partici-
pate in its network.
An entity that uses an authorized agent to report and/or query on its behalf still retains responsibility for making credentialing determinations for its practitioners. The entity that delegates credentialing is not
considered part of the credentialing process
and is prohibited from receiving NPDB query
Hospitals may not delegate their responsibility to query because of the federal mandate for
hospitals to query the NPDB when a practitioner applies for a medical staff appointment or
clinical privileges and every two years thereafter. Health plans are the most common
delegators of credentialing, most often to hospitals.

Check out the NPDB page for more information about the differences between delegated credentialing entities and authorized agents.

And as always, thanks for reading!

Monday memo: Revisit privileging for ambulatory settings

TIPPhysician privileges have jumped from the medical staff services department to front-page news, as Becker’s ASC Review noted:

“An ear, nose and throat (ENT) specialist present in the New York City-based Yorkville Endoscopy operating room where Joan Rivers was undergoing an endoscopic procedure on her vocal cords did not have privileges to practice at that clinic, according to a report from The New York Times.”

The ENT physician examined Rivers both before and after the gastroenterologist performed an upper endoscopy, according to the report. Neither physician has been accused of wrongdoing by the New York State Department of Health.

National Public Radio subsequently aired a story that looked at privileging in outpatient surgical centers in general.

Although I usually prefer it when privileging stays out of the public eye, a higher degree of scrutiny might give more people outside the medical staff services department an inkling of why privileging and other MSP tasks are so important.

That’s my 2-cent tip for Monday. You can add yours here.

Thanks for reading!


Take a break?

Beach picI thought about work while I was on vacation last week: I wondered, “When CRC readers get a break, what do they do?”

Our most recent MSP Salary Survey found that 50% of respondents handle credentialing and privileging for as many as 400 practitioners, and 21% reported that their department credentialed 1,000 or more. In interviews this year I’ve spoken with MSPs who handled all or most of the credentialing and privileging for multiple facilities—all while keeping MEC meetings on track, keeping their part of hospital operations as survey-ready as possible, and putting out the myriad little fires that go with the territory.

So, as we head into a three-day weekend, what will you do to unwind? Will you think about work? Let me know.

Happy Labor Day and thanks for reading!

Meet your credentialing challenges

shutterstock_139733149 (2)There’s still time to register for our webcasts, Verify and Comply: Meet Your Top Credentialing Challenges, on Tuesday, September 4, from 1:00 to 2:30 p.m. Eastern Time.

Join Carol Cairns, CPMSM, CPCS, for this webcast if you’re struggling to understand what CMS, The Joint Commission or other accrediting bodies are looking for, or if you’re just striving to develop the best practices for credentialing and privileging.

After this program, participants will be able to:

  • Describe credentialing best practices
  • Identify the similarities and differences among regulators and accreditors (including CMS, The Joint Commission, DNV, HFAP, and NCQA)
  • Differentiate old medical staff standards language and “urban legends” versus current requirements
  • Clarify vague standards and unclear terminology
  • Distinguish between what must be done to ensure compliance, what is actually being done, and best practices

Click here for more information or to register.

Thanks for reading!

Son Hoang, associate editor, Credentialing & Peer Review Legal Insider

An insider’s view of a practitioner turf conflict

Jack Cox, MD, MMM, one of the authors of Resolve Practitioner Turf Conflicts: Medical Staff, AHP, and Offsite Disputes, sat down with HCPro to share his personal experience with turf conflicts as both a physician and physician executive:

It seems like a small issue, but sometimes what appears on the surface as an inconsequential turf battle among well-meaning physicians trying to maintain market share can result in everyone losing.

Recently we had an issue that has not fully played out, but I can speculate on the outcomes if we don’t resolve it. In developing a comprehensive cancer program for melanoma, we have run into an issue of different specialties all claiming expertise in the field, especially in the area of surgical intervention. The health system is looking to invest heavily in this new comprehensive program, and success—which it has had in other areas like breast and GI cancer—would mean an increase in patient volumes for all the affiliated physicians.

But back to the issue: The general surgeons, the plastic surgeons, the dermatologists and even an ENT physician all claim to have expertise with melanoma surgical excision. We recently recruited a fellowship-trained melanoma/sarcoma surgeon who is willing to help train others, but the turf lines have been drawn.

The challenge is, of course, the short-sighted nature of everyone wanting to protect their “slice of the pie” when the focus should be on how to increase the size of the pie. This is not an uncommon scenario, especially in this time of major healthcare transformation, when everything feels unstable and we regress to protecting what we can see today. Strategic thinking is out.

Now more than ever, we need to anticipate potential turf conflicts, be willing to view solutions in a different way, and think of a more strategic outcome that will be better for all. Otherwise, we all suffer the consequences of holding onto our preconceived notions of what is fair. Preparation and developing a process in advance, as well as having the right people at the table, goes a long way in avoiding the above scenario.

Monday memo: Plan for September

TIPAllegations of physician misconduct and negligence. “Assistant physicians” in Missouri. Expanding NP practices in Kentucky. This week’s Credentialing Resource Center Insider news roundup showcases several potential credentialing challenges. Learn how to handle some of the toughest issues your department will face by tuning in to Verify and Comply: Meet Your Top Credentialing Challenges, a webcast slated for September 4, from 1:00 to 2:30 p.m. Presenter Carol S. Cairns, CPMSM, CPCS will help you cut through the confusion when CMS seems to want one thing for medical staffs and accreditors want something else.

I know you’re probably not ready to think about September, but if you put this web presentation on your radar, you could start fall with a better understanding of credentialing best practices.

Thanks for reading!

Mary Stevens, editor, Credentialing Resource Center Insider

Monday memo: Register for Wednesday’s webcast

TIPWith the changing demographics of the hospital medical staff comes growing challenges to collecting and assessing information on physician competence. When physician leaders do have this information, they often don’t know what to do with it. What steps should they be taking with this information? Can they work with the physician to help him or her improve (collegial intervention) or should they suspend/limit the physician’s privileges (corrective action)? This program will walk medical staff leaders through the steps of collegial intervention through corrective action and discuss how to do so while protecting patients, the physician, and the organization.

After this program, participants will be able to:

  • Identify why the change in demographics will eventually create an increase of issues with physician competency
  • Comprehend the range of assessment tools for evaluating the competence of clinically suspect practitioners
  • Understand the full range of disciplinary tools available to problem physicians
  • Conduct peer review while minimizing legal liability

Click here to learn more about this webcast.

CPRLI readers, we want to hear from you

Medical-LawWhat would you change in Credentialing and Peer Review Legal Insider? What should we keep on doing? We’re asking CPRLI readers to take a short survey to help make this publication an even more valuable asset for medical staff services departments, medical staff leaders, and legal teams in healthcare organizations.

Please take a few minutes to complete this short survey. Click here to get started or type in your browser. Respondents can be included in a drawing to win a copy of “Resolve Practitioner Turf Conflicts: Medical Staff, AHP, and Offsite Disputes,” by Jack Cox, MD, MMM; Rosemary Dragon, CPMSM, CPCS; and Christine Hearst, CPMSM.

Thanks for reading!

Monday memo: Know what data can show

TIPProPublica’s analysis of recently released Medicare data has gleaned some interesting findings—a significant number of physicians with “unusual” Medicare billing patterns have been disciplined by their state medical boards or have had challenges to their licenses. The article sheds light on the challenges of using data to identify potentially suspect physicians.

If physician leaders in your organization have collected data, assessed physician competence information, and found issues, what should their next steps be? Tune in Wednesday, July 9, 1:00-2:30 p.m. Eastern for Assessing and Managing Clinically Suspect Practitioners: From Collegial Intervention to Corrective Action, a webcast presented by Todd Sagin, MD, JD, former vice president and national medical director of The Greeley Company, Inc.

This program will walk the audience through steps for handling clinically suspect practitioners while protecting patients, the physician, and the organization. Audience members will learn to identify when working with the physician to help him or her improve (collegial intervention) is the best option, and when they should suspend or limit the physician’s privileges (corrective action).

Click here to register or learn more about this webcast.

Thanks for reading!

Monday memo: Revisit the cost of credentialing

DollarSignsA recent visit to the Credentialing Resource Center archive yielded questions and an article about the cost of credentialing practitioners. The original story, published in 2010, reported that costs ranged from approximately $430 to $800 per practitioner, including labor.

Maybe that range matches what you see in your organization—but with so many changes in hospital systems, information technology, and the economy in general, maybe the range has moved higher. (Or lower?) So perhaps it’s time to ask again: Does your medical staff services department track how much it costs to credential each individual physician at your organization? Do you track how much it costs to perform primary source verifications for advance practice professionals?

If you’d like to participate in a Credentialing Resource Center Journal article about this topic, please let me know.

Thanks for reading!