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PubMedDate not supplied

Using electronic provider credentialing to address the quality revolution.

In recent years, provider credentialing has emerged as a quality initi ative for managed care organizations (MCOs). To satisfy the quality concerns of insurers, purchasers and patients, network officials are seeking industry accreditation, which requires credentialing. But while many organizations are conducting credentialing, it can be an underutilized and misunderstood resource. Credentialing is not an end in itself; it is the first step in building a quality management system. Used in this context, credentialing confers enormous advantages that go far beyond basic background checks.

Accreditation↗
PubMed1980

Current and future credentialing in respiratory therapy.

Increasing demands by society in the United States for better, more efficient, and readily available health care have led to development of numerous categories of health practitioners. After a decade of vigorous growth, the emergence of new kinds of specialized health personnel raises questions of legal authority and quality of care. The multiplicity of health care professions often results in duplication of effort, fragmentation of services, and overlapping of job responsibilities, which contribute to ineffective regulation of health care personnel. Historically, credentialing has been the hallmark of professional accountability. All forms of credentialing are intended to provide the public with safe and effective care, but unfortunately the current system has led to ineffective regulation of health care personnel. Respect for professionalism has diminished in the public eye as consumers are questioning whether the elaborate, multiple, and costly mechanisms of current credentialing really protect society. Three types of credentialing currently in use are accreditation of institutions and educational programs, licensure of practitioners, and certification or registration of practitioners. These mechanisms of credentialing are not adequately assuring the competency of health practitioners; therefore, proposed alternatives such as institutional licensure, administrative regulation, national certification, and proficiency examinations should be explored.

Allied Health Personnel↗
PubMedDate not supplied

Economic credentialing: the propriety of managing physician costs through privileging.

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.

American Medical Association↗
PubMed2000

Challenges of including dietitians, nurses, occupational therapists, and pharmacists in the Federal Credentialing Program.

Credentialing and recredentialing of federal health care providers involves hundreds of hours of labor and associated costs. This article presents the history of credentialing and efforts to expand the Federal Credentialing Program to include dietitians, nurses, occupational therapists, and pharmacists and discusses barriers to this possible expansion. Representatives from federal and civilian health care service delivery agencies and credentialing and licensure bodies will gather to establish common credentialing information for these professions. Discussing barriers to these efforts will help to ensure success. In addition, a more efficient and streamlined system could easily be adopted by the civilian sector for these professions.

Credentialing↗
PubMedDate not supplied

The inefficiencies of present systems for physician credentialing.

The requirements of physicians credentialing have become standardized through the broad acceptance of the credentialing standards developed by the major accrediting bodies. However, attempts to share credentials documentation and data have been few, resulting in much redundancy among credentialing programs and excessive application paperwork for physicians. This article describes recent initiatives in the standardization of application forms and office site reviews and in the sharing of physician data. Also discussed are questions that have been raised in recent years about the value of some information that has traditionally been considered in physician credentialing.

Credentialing↗
PubMed1981

Applying antitrust law to medical credentialing.

This Article analyzes the possible antitrust liability of medical credentialing programs by dividing their potentially anticompetitive acts into three categories: (1) communicative behavior--for example, credentialing agencies' promulgation of standards--designed primarily to influence government decision making; (2) communicative behavior designed to influence private decision makers, such as consumers, hospitals, and training programs; and (3) noncommunicative behavior--for example, an agreement by the credentialing agency and others to boycott a group of professionals--that might be used to exclude competitors from various fields of medical care. The author argues that the first amendment of the U.S. Constitution, together with the related Noerr-Pennington doctrine, should exempt from antitrust law any credentialing standard that has been adopted for a good-faith purpose and is at least arguably reasonable. On the other hand, the author also argues that antitrust law should condemn any "sham" standard that in fact is designed to eliminate or to punish competitors, and any other noncommunicative behavior by credentialing agencies for the same purpose.

Accreditation↗
PubMed2005

Endovascular training for obstetrician-gynecologists: Suggestions for credentialing.

This article suggests guidelines for training and credentialing of obstetrician-gynecologists to perform endovascular procedures. It concentrates on the performance of uterine artery embolization for symptomatic myomata. Comparison is made between other recommended case numbers for credentialing of surgeons, radiologists, and cardiologists. Educational courses are discussed, as are the credits obtained for a typical uterine artery embolization. Two paradigms of endovascular credentialing are appropriate for comparison: Cardiology standards for coronary artery interventions and vascular surgery standards for endovascular stent placement. Both require a course including laboratory and participation in 100 cases, 50 of which as primary operator. In addition, many countries require a certificate of fluoroscopy safety. A credentialing board will be created to verify both the standards and completion of course requirement and proctored cases. Credentialing will benefit both patients and obstetrician gynecologists who will be able to provide continuity of care not currently available. The gynecologist will be able to manage all complications, including myomata, which cannot be done under current circumstances.

Journal Article↗
PubMed1996

Forum on economic credentialing (E.C.).

What is economic credentialing? The California Medical Association defines economic credentialing as follows: "The use of economic criteria that do not apply to quality for granting or renewing medical staff pr ivileges?" The American Medical Association defines economic credentialing as " ... the use of economic criteria unrelated to quality of care or professional competency in determining an individual's qualification for initial or continuing hospital medical staff membership or pr-ivileges?" The Florida Medical Association defines economic credentialing as " ... any practice that denies access to hospitals based on eco- nomic criteria unrelated to the clinical qualifications or professional responsibilities of the physician." It also defines economic credentialing as " ... fiscal responsibility in practicing quality healthcare," and specifically notes that the governing body of a hospital has the right to discipline physicians (and presumably, exclude them) on the basis of resource utilization.

Journal Article↗
PubMed1995

Prudent expert systems with credentials: managing the expertise of decision support systems.

'Black box' expert systems (ES) are mistrusted by clinicians. Errors generated by medical ES are also a significant cause for concern. We report new ES properties--prudence and credentials--that improve error management and underpin a new approach for improving the credibility of ES for clinical users. Prudent ES modify their output according to past experience. For a knowledge base built from 1610 cases, feature exception prudence (FEP) detected all interpretation errors (100% sensitivity for error detection). Although the false positive rate for FEP was high (47%), the 100% sensitivity meant that the 53% of cases that did not produce flags could be exempted from human validation. As more cases are processed, fewer cases should need human validation. Feature recognition prudence (FRP), a property of ripple down rules (RDR), proposed the correct alternative conclusion in 14% of incorrectly interpreted cases. Human expert validation of the flagged cases enabled context-sensitive credentials (accuracy, incidence and specificity of a given conclusion) to accumulate. Credentials should enable the user to judge the credibility of the ES output. An error management strategy based on credentialed, prudent ES should reduce the impact of error in the clinical environment. The empowerment of clinicians to critically evaluate ES credibility may facilitate greater confidence in, and acceptance of, ES by clinicians.

Artificial Intelligence↗
PubMed2006

Improving hospital surge capacity: a new concept for emergency credentialing of volunteers.

In the event of a large-scale terrorist attack, natural disaster, or other public health emergency, hospitals could not absorb the thousands of victims generated by the catastrophe. Even if hospitals can increase bed capacity by 20% to 30%, as some suggest, the problem of staffing these beds remains unresolved. One possibility is to rapidly increase hospital staff by providing emergency credentialing to volunteer health care professionals. Several organizations and systems currently exist that can deliver medical providers to a stricken area. Unfortunately, all of these have serious limitations that would make it difficult for hospitals to use the health care workers provided by such entities. We propose a unique concept that will allow hospitals to rapidly expand their staff with practitioners that meet their credentialing requirements. The concept is a database created by each hospital in a community that includes credentialed physicians, nurses, behavioral health professionals, and ancillary staff. The database will be limited to physicians with full privileges and all licensed hospital employees in good standing not currently facing disciplinary issues or practice restrictions. The individual databases would then be combined and stored on a single computer system housed at the county health care agency or other mutually acceptable organization, with copies sent back to participating hospitals and the state. After a large disaster, health care workers from unaffected areas, including other states, can approach affected hospitals and volunteer their services. Practitioners listed on the database could be given privileges in their specialties for 72 hours. This process is accurate, inexpensive, efficient, sustainable, and Joint Commission on Accreditation of Healthcare Organizations compliant and permits the immediate credentialing of large numbers of medical volunteers.

Credentialing↗
PubMed1991

How completely internal medicine residents at a New York State teaching hospital met the expectations of a credentialing protocol.

The authors conducted a two-year prospective study (1988-1990) to determine whether internal medicine residents at a multi-facility teaching hospital in New York State could meet the expectations of a formal credentialing protocol and receive independent privileges in a timely manner. The study group consisted of 38 first-year residents separated into two subgroups. Subgroup I, seven categorical and 11 preliminary residents, entered the residency program July 1, 1988; subgroup II, seven categorical and 13 preliminary residents, joined the residency July 1, 1989. During the first three months of the 1988-89 academic year, subgroup I showed minimal compliance, obtaining only 11% of the total privileges available. However, subgroup II, working under a protocol that underwent major revisions related to monitoring the credentialing process, showed significant improvement, with 90% of all required privileges credentialed within the first quarter of 1989-90. The findings suggest that a minimal rate of residents' compliance can be improved dramatically by the development of a structured protocol that includes stringent monitoring of the entire credentialing process and formal, regular feedback to the housestaff regarding their progress.

Clinical Competence↗
PubMed1989

Credentialing: a current perspective and legal background.

This article reviews the development of physician credentialing for hospital privileges over the last 30 yr. Important developments are discussed in the admitting and clinical privilege areas. The second part of the article considers the legal aspects to credentialing and the avenues for challenging credentialing denials. Finally, a generic credentialing form for physicians is presented for use by health care organizations.

Credentialing↗
PubMed1990

Effective physician credentialing. Properly monitoring medical staffs can protect hospitals from liability.

Healthcare facilities today are finding themselves increasingly liable in malpractice suits if they have hired incompetent physicians or allowed them to remain on the medical staff. Thus appropriate processes for physician credentialing are important. The hospital medical staff has the authority to evaluate medical staff membership status and clinical privileges and to take disciplinary and corrective action. If the medical staff fails to do its job, however, the hospital governing board is responsible for making sure the credentialing process is carried out properly. The same rules apply to the reapplication process. The hospital must associate its credentialing process with its prevailing concern for high-quality patient care and document that ideal. Preservation of market share and elimination of competition must never enter into the credentialing process. Well-framed hospital bylaws will help provide protection from liability, if they are followed correctly. If a hospital deviates from its bylaws when processing an application or granting clinical privileges, it risks a lawsuit. Congress has passed the Health Care Quality Improvement Act of 1986-an act that not only protects patients from incompetent practitioners but also can help limit facility's risk of liability by requiring facilities and third-party payers to report any adverse actions taken against physicians. The National Practitioner Data Bank is an information clearing-house opened in September 1990 that hospitals must use to report and obtain professional information about physicians.

Constitution and Bylaws↗
PubMed1991

Physician economic efficiency--a new factor in credentialing.

"Economic credentialing"--the use of economic indicators in evaluating physicians for the purposes of staff appointment and reappointment--is a controversial new development in the ongoing struggle to control hospital costs while maintaining quality patient care. This article describes the concept of economic credentialing, discusses some of the legal considerations raised by the use of economic criteria in the credentialing process, and presents the findings of a recent study of the utilization of economic credentialing in hospitals today.

Antitrust Laws↗
PubMed1998

CM credentials: it's quickly becoming a case of when, not if you must.

Many case managers feel pressured by an increasingly competitive job market to take advantage of the recent proliferation in case management credentials and degree programs. And data suggest that credentialed and better-educated case managers can bring home significantly higher salaries. Even so, some experts are critical of the trend toward raising the educational requirements for some of the top case management credentials. At issue is whether the bachelor of science in nursing should be regarded as a minimum standard for the practice of case management. Most experts agree, however, that having a credential indicates that a case manager is attempting to broaden his or her base of knowledge and stay current with trends in quality and patient care.

Case Management↗
PubMed2005

A model for clinical credentialing of dental school faculty.

Committed to the premise that the same standards of review for clinical practice may be applied to clinical teaching, The University of Texas Health Science Center Dental Branch at Houston began credentialing clinical faculty in 1997 as part of its quality assurance and risk management program, one of the first dental schools in the country to do so. Credentialing, modeled after health care institutions such as hospitals, is general and procedure-specific involving the review of qualifications such as licensure, training, education, experience, and performance of professional practitioners; measuring those qualifications against pre-established criteria; and granting of "clinical privileges" to clinical faculty to perform or supervise procedures for which they are deemed qualified, based on that review. The development process included the leadership of the Quality Assurance and Risk Management Committee who met with all interested parties, explained the rationale and justification for credentialing, and successfully gained the support of the clinical department chairs, clinical faculty, faculty senate, and the administration of the school in implementing the credentials process. Evaluation of this process indicates that it has been useful in providing a mechanism to address a variety of patient care and clinical education issues such as faculty competency, compliance, and accommodations through a peer review process.

Accreditation↗
PubMed1983

Private credentialing of health care personnel: an antitrust perspective. Part One.

This Article explores the antitrust and other implications of private credentialing and accrediting programs in the health care industry. Although such programs are usually sponsored by powerful competitor groups, they serve the procompetitive purpose of providing useful information and authoritative advice to independent decision makers. Part One examines the risk that credentialing will sometimes be unfair to competitors and deceive consumers. Its survey of common-law, antitrust, and regulatory interventions to correct such unfairness and deception seeks to determine the degree of oversight to which credentialing and similar activities have been and should be subjected. In recommending that judicial or regulatory scrutiny should be limited to discovering whether standards and practices have a rational relation to a procompetitive purpose, the Article argues that greater intrusion into credentialing schemes would be inconsistent with market theory and first amendment values and would discourage line-drawing efforts that stimulate competition and facilitate consumer choice. By emphasizing throughout that personnel certification and institutional accreditation embody ideology and opinion as well as factual information, Part One sets the stage for the argument in Part Two that antitrust law can and should be used to contest the dominance of a single ideology of health care and to facilitate the development of alternative sources of consumer information. The Article's overall thesis is that, whereas the quality of advice given to the public about health care personnel and similar matters should not be closely regulated, neither should the supply of competing information and opinion be artificially curtailed.

Accreditation↗
PubMed1982

Dental technology program administrators' attitudes toward credentialing health manpower.

The purpose of this study was to identify the attitudes of administrators of dental technology programs toward health manpower credentialing. A survey instrument was developed by allied health professionals knowledgeable in the credentialing process. The instrument contained 32 items that were categorized into three subscales and sought information about academic program accreditation, certification, and the licensure of dental technicians. The survey was sent to the directors of the 57 dental technology programs accredited by the American Dental Association, Usable returns totaled 49, or 86 percent. The data indicated that dental technology program administrators support the concept and practice of health manpower credentialing. The data also indicated that these administrators felt that academic program accreditation was of value in meeting demands for quality assurance in dental technology, and that certification of technicians, while beneficial, had been of little value in terms of rewards (recognition and economic gains) for the credential holder. In addition, licensure of dental technicians was found to be desirable.

Accreditation↗