Credentialing Resource Center Daily

Develop robust privileging criteria

July 21, 2016 | Credentialing Resource Center Daily

Given the growing diversity in hospital specialties, competency assessment should tap many sources, rather than relying too heavily on any single channel. And prospective criteria sources are abundant, according to David J. Siegler, MD, a pediatric physician with Child Neurology of Tulsa, an independent solo practice. He points to a number of activities physicians do to stay current. “That includes teaching, self-reading, mentoring other physicians, being mentored by other physicians, attending work-shops, and seeing patients every day.”

Resolve privilege disputes with a policy

July 20, 2016 | Credentialing Resource Center Daily

This week’s free resource comes from Resolve Practitioner Turf Conflicts. Privilege disputes require the cooperation of your medical staff and administrative leadership to resolve. The development of a policy that allows for the collaborative efforts of the medical staff, administration, and the ancillary and AHP staffs can aid in quelling “fear of the unknown” and in breaking down barriers.

Transition to a criteria-based core privileging

July 19, 2016 | Credentialing Resource Center Daily

A criteria-based core privileging system ensures consistency, flexibility, efficiency, and objectivity but making the transition can be a daunting and overwhelming task. Take the hassle out of that transition with Criteria-Based Core Privileging: Guide to Implementation and Maintenance. This book provides the necessary steps for medical staff and credentialing leaders to successfully adopt a criteria-based system.

Scope of privileges at the ambulatory site

July 18, 2016 | Credentialing Resource Center Daily

When a hospital has established which ambulatory sites require practitioners to be privileged, its medical staff needs to evaluate the scope of services provided at the site by physicians and advanced practice professionals, such as nurse practitioners and physician assistants. Thereafter, the medical staff delineates site-specific privileges and commensurate criteria.

Prescreen candidates for employed physician positions

July 13, 2016 | Credentialing Resource Center Daily

An effective prescreen process helps to ensure that nonviable candidates for employment never make it to first base. It also helps to minimize the risk of throwing open the door to due process if an application to the medical staff is offered and then denied after you have formally started to process it. Finally, while an executive champion might be required to jump start and work through the initial organizational roadblocks, once formulated, the prescreen becomes standard operating procedure among frontline staff.

Five simple tips to help healthcare organizations prevent fraud

July 12, 2016 | Credentialing Resource Center Daily

It's impossible to calculate the amount of healthcare fraud that exists, as much of it slips under the radar. However, healthcare fraud poses a serious problem, putting the health and welfare of beneficiaries at risk while costing taxpayers billions of dollars.

Preventing healthcare fraud and abuse is challenging, especially for hospitals, hospices, and other similar organizations. While there are a lot of honest and well-intentioned healthcare providers, there are quite a few perpetrators--ranging from street criminals to large companies. As such, owners of healthcare organizations need to be on their guard at all times. After all, allegations of fraud and abuse against low-level or top brass employees can affect the reputation of any healthcare organization.

Avoid granting privileges to excluded practitioners

July 12, 2016 | Credentialing Resource Center Daily

The Office of Inspector General maintains a List of Excluded Individuals/Entities (LEIE) database, which is updated on a monthly basis. Medical staff stakeholders can search the database to identify entities and individuals who are excluded from Medicare, Medicaid, and other federal healthcare programs.

Get new medical staff leaders up to speed on credentialing

July 11, 2016 | Credentialing Resource Center Daily

This week, CRC Daily covers credentialing, which is among the many duties that require effective collaboration between medical staff leaders and MSPs. It is a mistake to assume that a practitioner who has been on the medical staff for a while and has gone through the application process automatically understands the behind-the-scenes workings of credentialing. Today's post highlights some of the credentialing truths that must often be pointed out or explained to new medical staff leaders. 

Do employed physicians automatically lose clinical privileges if they are terminated?

July 07, 2016 | Credentialing Resource Center Daily

Your organization must decide if it will include co-terminus language in the employment agreement regarding employment and privileges. This means that if the physician is terminated, he or she automatically loses medical staff membership/clinical privileges. If there is no co-terminus language, the formerly employed physician will retain medical staff membership and/or all granted privileges at your organization. If your organization is all right with this arrangement, then there is no problem. They remain at your organization but are no longer a health system-employed physician.

Review your privilege forms

July 06, 2016 | Credentialing Resource Center Daily

Your clinical privilege forms need to be reviewed on a regular basis to ensure they reflect up-to-date criteria requirements and standards for the procedure or specialty in question. For example, a procedure that used to be considered a special, noncore privilege when you developed your forms could now be considered within the core of that specialty because the procedure is performed so often by the specialists. This is the type of thing you want to check for when reviewing your privilege forms.

Electronic tools fan the flames of physician burnout

July 05, 2016 | Credentialing Resource Center Daily

Add electronic health records systems to the list of factors that contribute to physician burnout. Physicians who use EHRs and CPOEs are not just less satisfied with their clerical burdens, but also at higher risk for professional burnout, according to a national study of physicians led by Mayo Clinic.

So far, EHRs and computerized physician order entry systems aren't making good on their promise to make physicians' lives easier.

Involve MSPs in medical staff orientation

July 05, 2016 | Credentialing Resource Center Daily

The Medical Staff Office Manual: Tools and Techniques for Success is an on-the-job desk reference for new and experienced MSPs. This book is a comprehensive guide that maps every aspect of the medical staff office, from credentialing and privileging physicians to querying other facilities for practitioner information and effectively collaborating with physician leadership.

Make your bylaws inclusive

June 30, 2016 | Credentialing Resource Center Daily

A lot of medical staff bylaws restrict board certification to American Board of Medical Specialties (ABMS) and its member boards—again, sometimes unintentionally. Doing so blocks physicians certified by osteopathic boards, non-U.S. boards, and any new boards created not under ABMS.

Completion of history and physical examination sample bylaws language

June 29, 2016 | Credentialing Resource Center Daily

The Centers for Medicare & Medicaid Services requires medical staff bylaws address who can perform the history and physical examination and in what time frame the history and physical exam must be completed. This week’s free resource is sample bylaws addressing the completion of history and physical examination.

The MEC and bylaws

June 28, 2016 | Credentialing Resource Center Daily

Physician leaders are pressed for time. The Medical Executive Committee Manual provides them the knowledge and tools to confidently and effectively carry out their responsibilities. With this manual, MEC members will understand important medical staff functions, such as the role the MEC plays with bylaw and governing documents. Topics covered include:

Medical staff bylaws and associated documents

June 27, 2016 | Credentialing Resource Center Daily

The medical staff bylaws and associated documents outline how the medical staff will organize and govern itself to carry out its board-delegated responsibilities to ensure the quality of care, which primarily depends on individuals granted privileges. At a minimum, they outline the credentialing and privileging process and the initial and ongoing review of physician competency. Additionally, there is generally an extensive outline of due process, which is extended when the medical staff finds itself at the level of managing poor performance or considering whether a corrective action is warranted.