#NAMSS2018 Attendees Pin Success on Managing Change: Meeting Top Credentialing Challenges as Patient Care Evolves
From the opening keynote, which shared Mahatma Gandhi’s quote: “Be the change you wish to see in the world,” to all of the discussions our team participated in, it was visible and clear at this year’s annual convention of the National Association of Medical Staff Services, that MSS teams are rising to the challenge and embracing change.
Attendees who visited the SkillSurvey booth participated in our live poll by selecting a pin that signified their top credentialing challenge. The top pins, and therefore biggest challenges, were Peer Referencing, Managing Follow-up Tasks, and Application Delays. It is no wonder with the changing Joint Commission standards, especially as they relate to the delivery of care.
Laura Barnett, Director of Product Management, Credentialing at SkillSurvey said, “The poll results are not surprising when you consider the incredible transformation taking place in healthcare services like the increase of telemedicine and outpatient facilities. These changes are multiplying and changing credentialing teams’ handling of peer reference requests, processes and workloads.”
How to Effectively Bring Change to your Healthcare Organization
It’s clear that credentialing teams have much to stay on top of and must lead with new ways of managing the process. SkillSurvey hosted a luncheon panel with four credentialing leaders focused on the topic of change. The panel included Paula Bargo, UK HealthCare, Caren Cashell, The Ohio State University, Wexner Medical Center, Luisa Godfrey, Intermountain Health, and SkillSurvey’s Linda Van Winkle. We’ve included a summary of the session highlights:
Obtaining buy-in for adopting new credentialing programs
Caren Cashell advised that her team uses hardline, quantitative data to justify any new type of purchase. For example, tracking staff overtime spent on follow-up activities and comparing it to the cost of a new solution.
Building stakeholder support
Panelists noted how critical it is to have both your leadership and your team behind you when it comes to the decision-making process. Allowing stakeholders to experience a new solution can help move a process along. For example, one panelist sent SkillSurvey’s digital peer reference experience to their CFO and the chairman of the credentials committee so they could see firsthand how it improves the experience.
Physician leaders can play a significant role in supporting the case for new technology. Linda adds, “Administration is sensitive to physician satisfaction, especially with the growing physician burnout related to ‘paperwork’.”
Adding (or integrating) to your credentialing technology
It can be difficult to make the case for purchasing new or additional technology when you already have credentialing software in place. “For example, we see organizations that have excellent credentialing software, but that software does not handle the peer referencing function in an efficient, timely manner,” says Van Winkle. “Your direct report may not be aware of the needs you’re trying to meet day-to-day and the impact that new technology can have to reduce turnaround and make processes more efficient. Involve relevant administrative leaders and physician leaders in demos so they can ‘see the vision.’”
Kathryn Smith-Ripper from The Ohio State University – Wexner said, “The use of SkillSurvey Credential OnDemand has been a paradigm change in our process, and we have the metrics to back it up in terms of turnaround time.”
Cashell also shared that her team is closing out files much quicker. “Sometimes we get references back in 5-10 minutes. No fax, no printing.”
Other tips for getting support
Some other ways that you can build support, suggest that leaders contact their counterparts/peers at other organizations that use the technology you are requesting. Or, see if there is a short-term pilot to give your stakeholders an opportunity to experience the positive results of new technology.
The New Status Quo for Credentialing
An example: The increasing use of telemedicine and ambulatory centers means that credentialing teams need the flexibility to handle these applications with different peer referencing forms. As the practitioner shortage worsens, “distance medicine” will become more and more prevalent.
- Telemedicine is impacting credentialing by breaking down traditional boundaries for physicians and the physical state of “where” they practice. Telehealth standards are in flux and vary from state to state. In general, “distance practitioners” need privileges … not membership. New processes such as credentialing by proxy allow organizations to accept the credentialing and/or privileging decisions of a physicians’ “home” facility. The Federation of State Medical Boards now has arrangements with 17 states to grant reciprocity to telehealth practitioners.
- Health systems’ expanding use of ambulatory care and other centers is also adding to credentialing workloads and process changes. Employment in outpatient care centers is projected to grow 49 percent from 2014 to 2024 according to the Bureau of Labor Statistics.
The Joint Commission standards – 2018 update
SkillSurvey Credentialing Consultant, Linda Van Winkle, who attended a session on The Joint Commission notes that “Medical services professionals (MSPs) continue to be “front line defense” for assuring quality patient care as new standards develop.”
Here are some of the updates from the TJC that Linda recommends that MSS teams should review:
- LD.04.03.09 – Services provided by a pathologist through a contracted reference laboratory are NOT REQUIRED to be credentialed by the organization using his/her services if that laboratory is compliant with CLIA.
- MS.01.01.01, EP 37– For a multi-hospital system, the medical staff at each separately accredited hospital must be advised of the right to OPT OUT of the unified and integrated medical staff after a majority vote of its medical staff.
- Verification of Identity: There was much discussion about MS.06.01.03 EP5, pertaining to viewing of a valid photo ID for new applicants. The speaker stressed that organizations do not need to retain a photo; they are required to document that the applicant’s photo ID was viewed (before the practitioner’s first encounter to provide patient care.) It can be performed by individuals other than those in the credentialing department (e.g., Business Office, Security); BUT the credentialing policies and procedures need to specify this.
- Telemedicine – The presenter, a TJC physician surveyor, encouraged attendees to delegate telemedicine practitioner credentialing, FPPE, and OPPE to their telemedicine provider organizations. (TJC standard MS.13.01.01 EP 1)
FPPE: The surveyor also stated that recent hospital surveys are finding that a Focused Professional Practice Evaluation is not being performed on every practitioner. A period of FPPE must be implemented for all initially requested privileges … no exceptions.
OPPE: Ongoing Professional Practice Evaluation continues to be an evolving process, with hospitals struggling due to lack of resources. A good frequency for OPPE is every 8 months.
- Peer Review: Peer review should identify excellent care as well as questionable care and share that with practitioners.
- Verify and Comply
- RNFAs: Registered Nurse First Assistants (RNFAs) are required by CMS Standards to be privileged. (Standard 482.51(a)(4). Only grant RNFAs privileges for the functions the CMS says they can do. Because they are privileged, OPPE and FPPE are required, so don’t make the privilege delineation more detailed than the scope outlined by CMS.
- Peer References: TJC standards do not require peer references for reappointment if there is enough clinical activity and OPPE results in the file. For low volume practitioners or when insufficient data exists, a peer reference is required at reappointment.
- Surgical Privileges: CMS requires a written assessment by the applicant and confirmed by a peer of adequate health status related to surgical privileges.
- Board Certification/Maintenance of Certification: 16 states have passed legislation pertaining to requirements for physician board certification and maintenance of certification. Find out what your state’s requirements are.
- CVO standards: If you are a Credentials Verification Organization or use a CVO, the 10 guiding principles for a CVO can be found in The Joint Commission standards glossary. TJC requires an accredited organization to evaluate a CVO against these principles. The principles can also be seen on the AMA Masterfile website.
New credentialing and digital peer referencing technology can help MSS teams keep pace with the dramatic changes coming their way. With 24×7 access, MSS teams, applicants and their recipients respond and provide needed information on their own time – no matter where they are (or how many places they work)!