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Hugh’s Credentialing Digest—Embracing Change, Produced by Hugh Greeley

May 31, 2017

Inspiring Physicians to Embrace the Change that Defines Success in Health Care is the topic for Hugh’s Credentialing Digest, Produced by Hugh Greeley

“The greatest barrier to a paradigm shift is the reality and incredible inertia of paradigm paralysis. A paradigm paralysis can be defined as the inability or refusal to see beyond current models of thinking.”

-Gilbert Mercier

Dear Colleagues,

My grandfather, Hugh P. Greeley, MD, an internist from Boston, Madison and Pilley’s Island, wrote the following in a 1917 issue of the Wisconsin Medical Journal: “Professions should pause periodically for stock taking.”

In medicine, that means reviewing the changes that have taken place and acting accordingly. If he were now chair of a modern credentials committee, he might begin a process designed to rethink and reform medical staff credentialing activity as we know it.

Why might this be a good idea for nearly all hospitals today? Nearly every thing defining the relationship between physicians and hospitals, and among physicians themselves, has changed over the past 15 years or so. Yet the systems and processes we use to vet new physicians and grant them permission to practice in our facilities have remained rooted in concepts born in the late 1960s and early 1970s (years before many physicians on your staff were born and before nearly all of them finished their medical educations.) Consider a few of the more significant changes we are now navigating.

Changes

* In many hospitals today, half of all physicians are employed or contracted.

* Many hospitals now derive the majority of their inpatient and outpatient revenues from employed or contracted practitioners.

* The legal issues surrounding credentialing are becoming more complex and costly.

* Increasingly, dedicated hospital-based doctors provide the majority of medical care delivered in the hospital.

* Physicians and other professionals are far more mobile today than in the past; few will begin and end their practices in one location (or with one employer.)

* Advanced practice registered nurses (APRNs) and physician assistants (PAs) are now commonly providing care in collaboration with or under the supervision of a distracted medical staff.

* The majority of primary care physicians now practice exclusively in the ambulatory arena, yet most are still assigned to traditional hospital medical staff departments.

* Telemedicine is here to stay, and it requires policies, procedures and skills that are significantly different than those used in traditional credentialing activities.

* Focused and Ongoing Professional Practice Evaluation (F and OPPE) requirements (for those accredited by The Joint Commission) require far more attention than can be expected from practicing physicians.

* Hospitals have morphed into systems with vastly greater complexity at the governance level.

* Many hospitals have a plethora of employed physician leaders (directors, vice presidents of medical affairs, heads of the employed group, etc.)

* Encouraging voluntary commitment to assist with credentialing activities is becoming difficult as physicians are pulled in many directions.

* Medical staffs and the requirements they must meet have not kept up with the evolution of the health care system and they perpetuate a hospital-centric model.

* The technology available today to gather and verify a practitioner’s background bears no resemblance to that used only years ago, yet most hospitals fail to capitalize on its availability.

* Those employees who assist in the credentialing process have become more sophisticated and better able to identify potential credentialing issues.

* The entire process of background checking and due diligence is moving beyond confirmation of competence and now includes many additional factors that might bear upon the employment or appointment of a practitioner.

Design factors:

* All easily available technology and data sources must be used when gathering data and information about applicants.

* All facilities must have systems that allow completed applications to move rapidly through the review and approval processes. No delays due to “scheduled” committee or board meetings should be allowed.

* Facility-specific duplication of effort must be avoided. To the extent permitted by law or regulation, single applications should be used for both employment and appointment to all related facilities within a system. A single point source of verification and data collection should be used with nearly complete sharing of information among the various departments charged with review or decision making.

Desired outcomes:

* Qualified and competent practitioners should be allowed to apply for both appointment and employment without unnecessary steps, and decisions should be made as rapidly as possible, considering patient and institutional needs as well as practitioner schedules.

* Unqualified practitioners or those with questionable professional backgrounds should be easily dissuaded from pursuing applications through the magic of “placing the burden on the applicant.”

* Medical staff hearings and appeals should be relics of a distant past.