Appropriate disclosure is essential to ensure that medical staffs have sufficient information to make informed decisions when granting clinical privileges to practitioners. Following is the second of my three-part blog series on proper disclosure and sharing of information.
Steps to ensure appropriate disclosure during credentialing
MSPs can play a direct role in keeping patients safe from practitioners with known competency issues in a number of ways, from making sure their bylaws require specific disclosure from practitioners, to thoroughly reviewing credentialing information from practitioners applying for membership and/or privileges. MSPs must also follow up when other entities, evaluators, or peer references do not provide complete information, or when the information provided is vague or raises additional questions or concerns.
Step 1. Ensure that the questions on your credentialing application are thorough. It is important that you ask the practitioner the right questions to ensure that all possible scenarios are covered for which he or she would be required to disclose information to your organization during the credentialing process.
You must also ensure that your attestation form (as well as your bylaws) indicates what the practitioner must disclose to you, and within what time frame, whenever something occurs after he or she has signed the application. For example, you would want to the practitioner to attest that, if any pertinent information on the application changes (including but not limited to licensure complaints, changes to affiliations, sanctions, etc.) he or she is required to notify you within a specified number of days.
Step 2. Ensure that the third-party release form (which should be a part of your credentialing application) is worded appropriately to allow the other entity or individual to disclose all pertinent information without the fear of retribution. A third-party release form should indicate that the practitioner who signs it grants permission and waives liability against all parties who release any information relevant to his or her credentialing and/or competence, so long as the information is provided in good faith.
Entities that are responding to inquiries should not provide detailed information without first receiving such release signed by the practitioner.
Step 3. Ensure that your competency verification forms or affiliation verification forms ask the right questions as well. If your verification request does not ask the right questions, you may not get full disclosure. For example, if you ask whether action has been taken ‘within the past two years’, the answer may be no; however, perhaps action was taken more than two years ago and the entity did not disclose it previously because it was not the policy at the time to disclose specific information.
Another example would be if you ask a clinical evaluator or peer reference if they are aware of any disciplinary action that “may impact his or her ability to exercise the requested privileges”—the answer may be no. However, these provider may be aware of disciplinary action that was taken, but they are not disclosing it to you because they do not feel that it would impact the applicant’s ability to exercise the requested privileges. Instead, you should ask questions that are open and applicable to any situation and are not limited.
In Part 3, we’ll explore the essential questions of information sharing: What should we disclose? And when?
When it comes to disclosing disciplinary actions taken against a physician or other practitioner granted clinical privileges, no news can be bad news—meaning, if an entity does not respond to requests for verification of the practitioner’s status, there may be a reason for the non-response. Both the entity requesting the information and the entity disclosing the information play a significant part in ensuring appropriate information is disclosed and shared between organizations. Appropriate disclosure is essential to ensure that medical staffs granting clinical privileges to practitioners have sufficient information to make informed decisions. Following is the first of my three-part blog series on proper disclosure and sharing of information.
Relevant legal cases related to disclosure
Most Medical Staff Professionals and Medical Staff Leaders are aware of the Kadlec Medical Center vs. Lakeview Anesthesia Associates case, where disclosure was at the heart of the suit. Kadlec Medical Center obtained peer references from Lakeview Anesthesia Associates during initial credentialing of an applicant. However, the peer references did not disclose that Lakeview Anesthesia Associates was aware of disciplinary action taken against the applicant in question. The affiliated hospital, Lakeview Medical Center, responded with a general template verification letter that did not disclose whether there had been corrective action taken at the facility while the physician held privileges there.
One of the key takeaways from this case is that the receiving hospital that is credentialing the provider must ensure that they have done their due diligence during credentialing—accepting a general verification letter that does not attest to whether there have been any quality or other concerns related to the applicant can lead to negligent credentialing claims. This case also signifies that failure to disclose information can later result in the third party being held liable if there are negative outcomes that may have been prevented had the third party fully disclosed prior actions that were taken against the applicant.
The case in Texas
A Texas case that’s currently in the news is likely to be the next significant case where disclosure during the credentialing process is one of the key elements of the debate. Christopher Duntsch, a neurosurgeon who eventually had his Texas license revoked, had corrective action taken by Baylor Health Care System for concerns related to his clinical competence; the concerns were brought forth by his peers. After the action was taken, Duntsch went on to practice at other hospitals in the Dallas area. Concerns are emerging with regard to what information Baylor had prior to granting him clinical privileges; it has been alleged in some reports that Duntsch’s peers warned Baylor of their concerns about him prior to Baylor granting him clinical privileges.
There are also concerns being reported regarding what information Baylor disclosed to other entities when they requested verification of Duntsch’s status at Baylor. Other hospitals that subsequently granted clinical privileges to Duntsch allegedly were unaware of the competency issues at Baylor until after they were facing significant investigations of their own related to poor patient outcomes—including paralysis and the death of at least one patient.
In one report it is alleged that one of the surgeons who was called in to correct complications after one of Duntsch’s surgeries was so astounded by what he found that he thought Duntsch might be an imposter. The report indicates that the surgeon faxed a photo of Duntsch to the neurosurgery training program in Tennessee where Duntsch trained, to confirm his identity. It will be up to the courts to decide whether Baylor shares some of the liability for the subsequent cases with poor outcomes at the other hospitals, if Baylor is found to have failed to disclose pertinent information to the other hospitals.
In my blog post next week, I’ll discuss the necessary steps to ensure appropriate disclosure during the credentialing process. Stay tuned!
In the final installment of the three-part webcast series “Overcoming Competency Assessment Challenges,” Carol S. Cairns, CPMSM, CPCS, senior consultant at The Greeley Company; and Sally J. Pelletier, CPMSM, CPCS, advisory consultant and chief credentialing officer at The Greeley Company, answered questions regarding practitioners in ambulatory settings, selective practice, and single practitioners in a specialty. We offered some of the questions and answers in the December issue of CRCJ.
Q: If we privilege practitioners at an ambulatory site, must we also do FPPE and OPPE?
A: The OPPE and FPPE terminology is from The Joint Commission. FPPE applies to organizations that are seeking or continue to have Joint Commission accreditation at the ambulatory and the acute-care site as well. If it’s a CMS accreditation process, or one of the other accrediting organizations, then a continuous performance monitoring process is required.
All of the accreditation bodies require some form of continuous competence assessment: The devil is in the details of the terminology. But if you’re a Joint Commission-accredited organization and you use FPPE and OPPE, then probably you need to conduct OPPE and FPPE on your ambulatory site practitioners.
This webcast, along with the entire series is available on our website. Click here for more information.
Thanks for reading!
After a soft launch in April 2013, the Educational Commission for Foreign Medical Graduates’ electronic credentialing verification offering, the Electronic Portfolio of International Credentials (EPIC), is quietly ramping up. And that’s according to plan, says William C. Kelly, MS, associate vice president for operations at ECFMG, based in Philadelphia. Kelly recently spoke with CRC about EPIC, which enables international medical graduates (IMGs) to provide credentials electronically, and lets medical schools verify credentials.
Q: EPIC has been online for about eight months now. Is it working as planned? What kind of feedback have you gotten?
Kelly: We launched after thorough testing (including SCRUM releases every couple of weeks). In April we finally finished what we through was the last little bit. EPIC launched in April, and it was a soft launch. It took couple of years to write the software and we’re confident in the new system.
We’ve made some tweaks based on initial user feedback. Most of what we had to tweak was in the instructions. We have to be accommodating to our applicants with regard to specifications, such as the proper size of photo, uploading of scanned diplomas and transcriptions, etc. We made changes so we could fix everything at our end if an applicant says “this is the diploma,” but it’s really the translation, or “this is my photo,” but it’s really something else. Those were things we worked on to make EPIC more user-friendly.
Q: Who uses EPIC?
Kelly: So far, it’s primarily been used by physicians who have gone through the ECFMG certification process. Many of them are probably interested in doing residence training or licensing in the United States, but not necessarily all. There are a lot more ECFMG-certified physicians than there are programs available. We have a certificate holders program—if a physician establishes an EPIC account, we add all of their primary-source-verified credentials that they had for the ECFMG certification program.
Our primary marketing efforts will be to international medical regulatory authorities, especially countries that don’t primary-source-verify all physicians who are going to their country.
Most countries have a verification system for physicians that train in that country, and there are a number of nations that verify their own IMGs, but may not require primary source verification on all practitioners. In these countries, EPIC can help because medical regulatory authorities just point the physicians to get their credentials verified through EPIC. There’s a real benefit for the regulatory authorities.
That’s the focus now that we’re confident the system is robust.
Q: What other countries’ medical institutions are using EPIC?
Kelly: ECFMG already does credentialing of IMGs who apply to practice in Canada and Australia. So, for example, everybody who’s trained outside Australia and New Zealand who is going to Australia has to have credentials primary-source-verified through us. We have a separate process for both Canada and Australia—they apply to the Medical Council of Canada or the Australian Medical Council, then the council electronically transmits the credentials they want us to verify.
We’re looking to other medical regulatory authorities and opportunities as well. Some do their own verification and some don’t do it all. Primary source verification is a time-consuming and labor-intensive process. We believe we have the expertise, and the organizational and training structure so if they want to start credentialing, ECFMG can do it for them. If they already do their own credentialing, they can delegate it to us.
This is a long-term process. We have the resources to take our time in developing this.
Today’s Monday memo includes a question and answer from our recent webcast “Overcoming Competency Assessment Challenges: All About Advanced Practice Professionals.” If the question sounds familiar, the answer might offer some clarity.
Q: Are the terms “collaborating physician,” “sponsoring physician,” and “supervising physician” interchangeable when it comes to requirements for advanced practice professionals?
A: That depends on your state law and what it defines as a collaborative or supervising situation as well as your own internal definition. Physician assistants are almost always supervised (Alaska allows for a collaborative plan), but nurse practitioners—depending on state statutes and individual hospital requirements—can either be supervised or can practice under a more collaborative arrangement or can practice independently.
I don’t see those terms as interchangeable, although organizations will frequently use them in the same context. Basically, practitioners can’t go hang out a shingle on their own or practice in a hospital setting if the hospital requires some type of a physician sponsor, collaboration, or supervision. Some states require a collaborative agreement, but hospitals might have stricter requirements and require something tighter such as supervision. If the hospital has stricter requirements for advanced practice professionals, “supervising” and “collaborating” may not be interchangeable in that setting.
On the other hand, a “sponsoring physician” could be either the supervising or collaborative physician. It depends on what your state and your organization requires.
— Sally Pelletier, CPMSM, CPSC, Advisory Consultant and the Chief Credentialing Officer, the Greeley Company, Danvers, Mass.
Click here for more information about this webcast or the others in this three-part series.
And as always, thanks for reading!
Mary Stevens, Managing Editor, Credentialing Resource Center
The National Practitioner Data Bank (NPDB) issued a press release earlier this week about the implementation of Section 1921, which expands the practitioner information the data bank collects. More details about the new Section 1921 regulation will be published in the Federal Register within the next five to 10 days.
Nevertheless, the press release revealed that Section 1921 will expand the information contained in the National Practitioner Data Bank (NPDB) to include:
- Adverse licensure actions taken against all licensed healthcare practitioners
- Any negative actions or findings by State licensing agencies, peer review organizations, and private accreditation organizations against all health care practitioners and entities
Anne Mitchell, RN and Vicki Galle, RN, two nurses from West Texas, tried reporting a physician’s problem behavior through designated hospital channels. When their complaints fell on deaf ears, they took the next step and anonymously reported the physician to the Texas Medical Board.
If you’re a follower of Rita Schwab’s Supporting Safer Healthcare blog you already know what happened next – the medical board notified the physician of its investigation. In turn, the physician contacted the local sheriff to file a harassment report. The sheriff’s investigation led to third degree felony charges for the nurses.
Newspaper columnists have also come out in support of the nurses, saying the state’s whistleblower laws should offer more protection.
What do you think of the case? Do you think a similar situation could occur within your medical staff?
Practitioners prescribing medication need to be licensed to practice in the state where they are prescribing, otherwise they could end up in prison like one former Colorado psychiatrist.
Christian Hageseth, a former psychiatrist, prescribed antidepressants after telephone patient consults. One out-of-state patient later committed suicide. Although an investigation found that the antidepressants were not linked to the death, Hareseth was sentenced to nine months in prison for prescribing without an in-state license.
“This really doesn’t have anything to do with telemedicine; it really has to do with following the appropriate protocols in both patient management and license credentialing,” says Dale Alverson, MD, president-elect of the American Telemedicine Association and medical director for the Center for Telehealth at the University of New Mexico Health Sciences told Modern Medicine in a June 5 article. “If you’re going to practice healthcare in another state, whether it’s virtually through telehealth or face to face, you should be duly licensed and credentialed.”
The Medical Board of California revoked Dr. Roy Chi Wing Lung’s medical license after he was found to have repeatedly stolen medical supplies from hospitals to sell on eBay, according to an Orange County Register article.
In 2004, the physician allegedly stole two computers from Long Beach Memorial Medical Center after showing up at the hospital in scrubs in an attempt to blend in.