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PubMedDate not supplied

The discontinuation of reciprocity agreements.

The ARRT discontinued reciprocity of certification with other credentialing bodies because it was the only way it could establish and maintain a single standard for credentialing of radiologic technologists in the United States. That single standard consists of requiring all new candidates for ARRT certification to pass the job-related examination of the ARRT. The ARRT was not the first of the four reciprocity partners to abrogate or discontinue its disagreement. For all practical purposes, the British, Australian, and South African partners had all discontinued true reciprocity of credentialing with the ARRT several years prior to the ARRT discontinuation. All foreign-trained technologists whose foreign training and credentialing would have qualified them for ARRT certification prior to January 1, 1986, are equally eligible in 1988. The only difference is that they now must pass the same job-related credentialing examination that American-trained technologists must pass in order to receive the ARRT certificate.

Credentialing↗

PubMed2003

The certified psychiatric nurse practitioner: advanced practice psychiatric nursing reclaimed.

During the decade of the 1990s, health care reform, market forces, population needs, new knowledge in neuroscience and changes in advanced practice regulation provided the impetus for the development of the role of the psychiatric nurse practitioner. Debate about issues of role, scope of practice, educational preparation, titling, and credentialing for the advanced practice psychiatric nurse (APPN) of the future intensified as the American Nurses Credentialing Center (ANCC) proceeded with its controversial decision to develop a certification examination for the psychiatric nurse practitioner-in advance of consensus among advanced practice psychiatric nurses about those widely debated issues. Ironically, now that the ANCC adult and family psychiatric nurse practitioner (PMHNP) examinations exist, with test content outlines that clearly identify the professional standards and scope of practice relevant to the role of the certified psychiatric nurse practitioner, those contentious issues of role, scope of practice, educational preparation and credentialing (if not titling) seem considerably less thorny. In fact, by credentialing the role of the psychiatric nurse practitioner sooner rather than later, ANCC may have saved advanced practice psychiatric nursing for psychiatric nurses. This article proposes to (1). explain that assertion, (2). clarify what the scope of practice relevant to the newly certified role means in terms of credentialing requirements for existing types of psychiatric nurse practitioner, and (3). identify some of the controversies that linger with the debut of the PMHNP certification examination(s).

Certification↗

PubMed2000

Use of radiology practice guidelines and compliance with accreditation standards in US and Canadian dental schools.

In 1992 and 1997, all US and Canadian dental schools were surveyed by mail regarding the preferred initial radiographic examination prescribed for non-emergency, comprehensive-care patients (dentulous adults, edentulous adults, and children). In both survey years, a minority of US and Canadian dental schools reported using selection criteria for dentulous adults and children, while nearly all schools reported doing so for edentulous adults. The purpose of this secondary analysis was to investigate the relationship between the use of radiology selection criteria (vs. predetermined routine examinations) in US and Canadian dental school clinics and three factors: (1) the credentials of the chief-of-service, (2) institutional funding, and (3) geographic region. "Credentials of the chief-of-service" is the single factor significantly related to the distributions of radiographic examinations prescribed for dentulous adults in both years (Fisher exact test, p < or = 0.02). There are no statistically significant relationships for edentulous adults or children in either year. Multivariate analyses (logistic regression) of the 1997 data reveal that institutions with a credentialed chief-of-service are 2.39 times more likely to report using selection criteria than institutions with a noncredentialed chief-of-service; private institutions are 1.13 times more likely than public institutions, and Canadian schools are 3.65 times more likely than US schools. A similar trend was identified for children. Analysis of the 1992 data revealed similar trends for the credentials of the chief-of-service and the geographic region, but showed no association between institutional funding source and the use of selection criteria. Contrary to accreditation standards, most US and Canadian dental schools obtained pre-determined routine radiographic examinations on most new patients. However, the presence of a credentialed chief-of-service had a positive effect on the use of selection criteria for dentulous adults and children.

Accreditation↗

PubMed1996

CCS (Certified Coding Specialist) examination--1995 results.

After four years, the CCS credential has matured and stabilized both as a credential and as a testing experience. Early complaints about the length of the exam, the difficulty of the cases, the readability of the exam booklets, and adequate room in the testing centers have been addressed and rectified. A significant step in the quality of the examination has been achieved by the cooperative arrangement between the COC, the SCC, and the COCC (renamed the Coding Policy and Strategy Committee in 1996). Each year about 1000 individuals take the CCS examination, and most individuals who earn the credential maintain it. The profile of the CCS candidate is remarkably consistent over the four years, indicating that a coding specialty examination fulfills an important niche in the marketplace. Respect for the CCS credential is reinforced as an increasing number of medical facilities require the CCS credential for coding professionals. AHIMA strongly supports coding specialization and standards of excellence in all aspects of clinical data management. For this reason, the COC and the CCS Construction Committee will continue to analyze the CCS skill set and to consider appropriate modifications to the examination as healthcare migrates to outpatient and managed care settings.

Abstracting and Indexing↗

PubMed2003

How useful is the information provided by the National Practitioner Data Bank?

BACKGROUND: The National Practitioner Data Bank (NPDB) serves as a federal information clearinghouse on malpractice payments for and disciplinary sanctions against health care practitioners. Hospitals are required to query the NPDB biannually for practitioners with clinical privileges, and other health care entities with significant peer review are encouraged to query the NPDB. A study was conducted to determine whether health care organizations find the NPDB useful. METHODS: A survey was conducted of 1,038 organizations that queried the NPDB between March 1998 and February 1999; 653 of those respondents also answered questions regarding 1,639 specific matched responses (feedback from the NPDB when the practitioner in question had one or more reports). RESULTS: Overall, the entities rated querying the NPDB as very useful (6.16 on a 7-point scale). More than 21% of matched responses contained new information, and this information altered institutional credentialing decisions in more than 5% of the cases. DISCUSSION: Many of the results from this study are consistent with findings in Office of Inspector General reports. The fact that 5% of credentialing decisions were altered because of NPDB information suggests that practitioner self-report is an inadequate mechanism for soliciting credentialing information. SUMMARY AND CONCLUSIONS: NPDB reports provide accurate and complete information that is useful to providers in their credentialing process.

Attitude of Health Personnel↗

PubMed1995

How to keep the Joint Commission happy and plaintiff's attorneys frustrated.

With the first minimum standard by the American College of Surgeons in 1918, the credentialing of physicians became formalized Since those days, in which a physician was basically required to be licensed and of high professional, moral, and ethical character, many requirements have been added. All have been appended for the safety and quality of care of our patients. However, liability attorneys have discovered credentialing requirements and found them a veritable gold mine for litigation. As rapidly as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) offers another standard to help us protect not only our patients but also ourselves in this litigation-bent atmosphere, attorneys engineer a way to bring suit, using the standard as if it were a requirement for prevention of negligence rather than a self-imposed goal for attainment of quality. This article presents a method of credentialing medical staff members that neutralizes the threat of antitrust actions alleging the compromising of livelihood by the denial of membership or clinical privileges. Additionally, the methodology offers maximal protection and integrity of credentialing procedures while optimizing compliance with Joint Commission standards.

Antitrust Laws↗

PubMed2001

Recredentialing in the allied health professions.

Credentialing of allied health professionals is used to assure the public that they are receiving care from competent individuals, and recredentialing is a means to demonstrate continuing competence. There is considerable variability in the requirements that allied health professions have for recredentialing. Of the 16 national credentials representing 14 allied health professions that were included in this study, 50% had no continuing education (CE) or retesting requirement in order to maintain the credential. The remaining 50% required CE in amounts ranging from 10 to 50 hours per year, with a mean of 18.5 hours. One credential requires both CE and retesting. A review of the literature reveals that CE requirements are not linked to improved patient outcomes, and evidence linking retesting to improved outcomes is lacking. Therefore, even though there is external pressure to implement recredentialing requirements for the allied health professions, care needs to be taken to assure that the tools used to ensure continued competence are valid and reliable.

Allied Health Personnel↗

PubMed2003

The occupation of healthcare management: relating core competencies to growth as a distinct profession.

There are many questions regarding the education of the healthcare manager. Some would argue that rather than focus on specific issues of core competencies and licensing, the discussion should be directed toward the successful development of healthcare management as a distinct profession. Two elements in defining a profession, education and legal restraints, are particularly relevant to healthcare management. It would be extremely difficult, if not impossible, for healthcare management to achieve recognition as a distinct profession in the traditional sense. There is no unique body of knowledge on which the profession is based, and no mechanism for credentialing to restrict practice. The organizational framework, however, does exist to better position the MHA-prepared graduate as the preferred candidate to manage healthcare organizations. A professional society needs to be identified as the representative society for the generalist healthcare manager. Core competencies should articulate the integration of academics and practice preparation. To accomplish the latter, academic accreditation requirements relating to faculty credentials should encourage practice-based credentials in addition to the current exclusive focus on academic credentials.

Credentialing↗

PubMed2004

Kathleen mears memorial lecture: educating the work force.

The roles and responsibilities of electroneurodiagnostic (END) technologists have changed significantly. The variety and complexity of procedures defined within the Scope of Practice for END Technology require that technologists be true professionals. External factors like state licensure, reimbursement issues, and the absorption of END procedures into the scope of practice of other allied health professions are a driving force toward mandated education and credentialing of END technologists. As a profession we must insist on formal education and proven competency through credentialing as entry-level requirements. Where does this leave non-degreed, non-credentialed technologists currently working in the field? How can these technologists continue to work and still fulfill these requirements? Or should they be required to do so? There are educational opportunities, resources, and a way to "fast track to boards" that will assist such technologists in educational endeavors and board preparation, equipping them to become true END professionals. The more qualified the END profession becomes through the continued educational pursuit of its members and the declaration of personal competency through the credentialing process, the greater impact it will have on the quality of patient care, employer attitudes, financial benefits, and legislative decisions that can directly affect it.

Allied Health Occupations↗

PubMed1977

Review of ADA licensure policy.

ADA policies on licensure encourage states to ease mobility restrictions while maintaining sufficient control to ensure that only qualified individuals provide dental treatment within the state. Many states have had provision to license by credentials for a long time. Licensure by credentials is rapidly replacing reciprocity as an alternate form of licensure. Only four states still participate in what can be termed purely reciprocal licensure agreements. In contrast, 21 states currently offer licensure by credentials. Another trend in licensure in recent years has been increased state participation in regional clinical examination services. Today, 32 states participate in four regional clinical examination services. With the increasing number of states offering licensure by credentials and participating in regional boards, the prospect for increased mobility for dentists appears good.

American Dental Association↗

PubMed2000

Accreditation of hospitals for percutaneous coronary intervention on the basis of volume or clinical outcome using MEDPAR data sets: effect on patient mortality, cost and treatment accessibility.

BACKGROUND: The risk of major complications of percutaneous coronary revascularization (PCR) is modestly lower in high-volume as opposed to low-volume hospitals, but this is not a consistent finding for all hospitals. There are also limitations comparing risk-adjusted outcomes between hospitals. We sought to ascertain the effect of credentialing hospitals for PCR, either on the basis of procedural volume or outcome, on clinical outcome, cost and accessibility to treatment, in states of varied population density. METHODS: We evaluated Medicare administrative data sets for all PCRs performed in 9 states during 1994Eth 1995. Based upon volume- and risk-adjusted in-hospital mortality during 1994, hospitals were OaccreditedO using varying volume and outcome thresholds, and the effect of accreditation using these thresholds was ascertained by analysis of 1995 outcomes. Sensitivity analyses were performed to assess the effect of altered assumptions. RESULTS: During 1994, one hundred and thirty-three hospitals performed 34,879 PCRs in Medicare patients, with an overall mortality of 1.36%. If credentialing were performed based upon 1994 volumes, a sizable clinical benefit could be expected only if large numbers of catheterization laboratories were OclosedO, e.g., if laboratories with < 200Eth 300 Medicare cases/year (< 400Eth 900 total cases) were OclosedO, mortality would be expected to decrease to 0.17Eth 1.07% (maximum and minimum effect). Costs could be minimized by closing laboratories with < 100 Medicare cases/year (best case scenario, $512Eth $905/patient). Such laboratory closures would require transfer to hospitals > 50 miles distant in 6Eth 38% of patients, but as many as 18Eth 94% of patients in low-density states. If credentialing were done on the basis of 1994 adjusted mortality, a somewhat lesser reduction of risk of death (best case scenario, 0.93%), but little improvement in cost, could be expected. CONCLUSIONS: If generalizable, these data suggest that to achieve a sizable reduction in procedure-related mortality by hospital-based credentialing, large numbers of catheterization laboratories would need to be closed and patient access to care would be adversely impacted. Cost savings of a very considerable magnitude may be more readily achieved.

Accreditation↗

PubMed1995

Is there a need for guidelines for OB/GYN residents to use the laser?

BACKGROUND AND OBJECTIVE: With the developing technologies and the extensive use of different wavelength lasers for treatment of some gynecologic conditions, many residencies in the United States face pressure to give credentialing to residents wishing to utilize the laser(s). The objective of this study was to assess the need for credentialing. STUDY DESIGN/MATERIALS AND METHODS: A survey was sent to all U.S. program directors of obstetrics and gynecology. RESULTS: Of 281 surveys mailed, 138 responded (49.1%); 136 utilized some wavelength laser in the treatment of some gynecologic conditions. The most commonly used laser was the carbon dioxide (CO2), and the least used was the argon laser. Eighty-four programs (61.8%) had a written policy; 54 (38.2%) did not. Postgraduate courses were necessary in 81 programs (59.6%), leading to some form of credentialing. CONCLUSIONS: The vast majority of programs (98.6%) utilized some wavelength laser as a therapeutic modality in gynecology, and 73.5% of the residency programs would like standardized guidelines for residents.

Credentialing↗

PubMed2004

The practice of bariatric surgery at academic medical centers.

The growing demand for laparoscopic bariatric surgery has led to an increase in the development of new bariatric surgical practices. Proper hospital facilities and an experienced bariatric surgical team are necessary to ensure optimal patient results. We surveyed academic centers participating in the University HealthSystem Consortium to examine the current practice of bariatric surgery. The survey questioned (1) availability of resources and equipment designed for the morbidly obese, (2) accidents, equipment problems, and workers' compensation relating to the care of bariatric surgical patients, (3) credentialing of bariatric surgeons, and (4) suggestions for improvements in the bariatric surgery program. Twenty-five institutions that perform bariatric surgery responded. Although the majority of institutions noted that they had basic bariatric equipment, some organizations did not have facility resources such as high-weight operating room tables and computed tomography scanners or transfer devices. Twenty-eight percent of institutions reported having accidents or equipment problems and 40% of institutions had workers' compensation claims relating to the care of bariatric patients. With regard to credentialing, 60% of institutions required the surgeons to have performed a minimum number of procedures prior to granting privileges. Suggested improvements included the need for more specialized bariatric equipment, enhancement of the education of all members of the bariatric surgical team, and designation of a bariatric physician who would coordinate care. This survey of bariatric surgery practices at academic medical centers demonstrates that the practice of bariatric surgery could be improved with regard to availability of bariatric equipment and resources and credentialing of surgeons.

Academic Medical Centers↗

PubMed2000

Advanced practice nurses in nephrology.

With the growing shortage of nephrologists and the increasing number of end-stage renal disease patients, collaborative practice arrangements between nephrologists and advanced practice nurses (APNs) are becoming more common. This report addresses both the credentials and scope of practice of nephrology APNs. Because the APN role in nephrology is multifaceted, role responsibilities in the nephrology office, chronic dialysis unit, and acute care setting are outlined. Nephrologists and APNs have overlapping scopes of practice, and practicing collaboratively allows each health care professional to use their strengths maximally. Barriers to practice and reimbursement issues are discussed. Documentation needed to enter into collaborative practice is delineated. This includes collaborative practice agreements, scope of practice statements, prescribing protocols, hospital credentialing, and dialysis facility credentialing. The goal of the collaborative practice model is to improve traditional patient care and delivery of services. The APN's role complements that of the nephrologist and offers a unique, holistic approach to the quality of patient care that is needed in the current health care environment.

Credentialing↗

PubMed2002

Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance.

BACKGROUND: Quality assurance of medical practice requires assessment of doctors' performance, whether informally via a system such as peer review or more formally via one such as credentialing. Current methods of assessment are, however, subjective or implicit. More objective methods of assessment based on statistical process control technique such as cumulative sum (CUSUM) procedure may be helpful. OBJECTIVE: To determine the usefulness and acceptability of CUSUM charting for assessing doctors' performance. METHOD: We applied CUSUM charting to assess doctors' performance of endoscopic retrograde pancreatography, renal and breast biopsies, thyroidectomy, and instrumental deliver. A CUSUM chart is a graphical representation of the trend in the outcome of a series of consecutive procedures. At acceptable levels of performance, the CUSUM curve is flat, while at unacceptable levels of performance, the curve slopes upward and eventually crosses a decision interval. When this occurs, the CUSUM chart indicates unsatisfactory performance. Thus, it provides an early warning of an adverse trend. RESULTS: All participating doctors found the technique useful to objectively measure their proficiency. CUSUM charts showed the progress of trainees in acquiring new skills. As they become more skillful with training, their CUSUM curves flatten. Among consultants, level CUSUM curves demonstrated ongoing maintenance of competence. All participants found the technique acceptable as a self-assessment tool. They were, however, less certain of its acceptability as a basis for credentialing. CONCLUSION: We recommend the use of CUSUM charting as a tool for personal audit at an individual level. It may also be used to show proof of technical competence for the purpose of credentialing.

Clinical Competence↗

PubMedDate not supplied

A different perspective on quality.

Evaluation of physicians in the credentialing processes of hospitals has generally been viewed as focused upon whether the physicians will provide services to patients at the appropriate level of professional performance and will not engage in disruptive behavior at the institution. Three measures--exclusive contracting, medical staff planning, and exclusive credentialing--have been employed, singly or in combination, at many hospitals to restrict or to deny medical staff appointments and clinical privileges to professionally qualified and competent physicians. Because the hospitals have articulated links, when employing these restrictive measures in making credentialing decisions, to the public's interest in their being able to provide good quality services to the communities they serve, the hospitals have usually been successful in litigation brought by physicians who have been denied staff appointment or specific clinical privileges.

Clinical Competence↗

PubMed2005

Nurse practice environments and outcomes: implications for oncology nursing.

PURPOSE/OBJECTIVES: To examine practice environments and outcomes of nurses working in oncology units or Magnet hospitals and to understand the association between the two. DESIGN: Secondary analysis of survey data collected in 1998. SETTING: Medical and surgical units of 22 hospitals, of which 7 were recognized by the American Nurses Credentialing Center Magnet program. SAMPLE: 1,956 RNs, of whom 305 worked in oncology units. METHODS: Chi-square tests compared nurse-reported outcomes by work setting, analysis of variance tested practice environment differences by setting, and logistic regression estimated the effects of practice environment, specialty, and Magnet status on outcomes. MAIN RESEARCH VARIABLES: Practice environments, emotional exhaustion, job satisfaction, and quality of care. FINDINGS: Oncology nurses had superior outcomes compared with nononcology nurses. Emotional exhaustion was significantly lower among oncology nurses working in Magnet hospitals. Scores on the Collegial Nurse-Physician Relations subscale were highest among oncology nurses. Outcomes were associated with Practice Environment Scale of the Nursing Work Index scores and Magnet status. Oncology nurses with favorable collegial nurse-physician relations were twice as likely to report high-quality care. CONCLUSIONS: Oncology nurses benefit from working in American Nurses Credentialing Center Magnet hospitals. Adequate staffing and resources are necessary to achieve optimal outcomes. Collegial nurse-physician relations appear to be vital to optimal oncology practice settings. IMPLICATIONS FOR NURSING: In addition to pursuing American Nurses Credentialing Center Magnet recognition, nurse managers should assess practice environments and target related interventions to improve job satisfaction and retention. High-priority areas for interventions include ensuring adequate staff and resources, promoting nurse-physician collaboration, and strengthening unit-based leadership.

Adult↗

PubMed2004

The American Board of Vascular Surgery and the law: fact and fiction.

The need for the establishment of an independent American Board of Vascular Surgery (ABVS) remains controversial. The controversy involves both medical and legal issues. These issues include medical malpractice, the attempt to create a "monopoly" by vascular surgeons, and the hospital credentialing of surgeons to perform vascular procedures. In this article, the legal impact of an independent ABVS on the filing of medical malpractice suits against vascular surgeons is explored. In addition, the legal criteria necessary to establish a monopoly, as well as criteria for hospital credentialing, are also reviewed. The results of this legal analysis are, first, that the establishment of an independent ABVS may well lead to a decrease in the number of frivolous lawsuits filed against vascular surgeons. Second, the establishment of an ABVS does not constitute the creation of a monopoly. Finally, hospital credentialing should not, and will not, be directly affected by the establishment of an independent ABVS.

Credentialing↗