Credentialing: Gatekeepers to Patient Safety

When a person is under medical care, the patient and his loved ones need to trust that the practitioner is educated, licensed, and trained in the specialty. And that’s where medical staff professionals (MSPs) come in. We maintain credentialing and licensure information, implement federal rulings and accrediting standards, and enforce the rules, regulations, and policies that govern the activities of medical staff.

The SpecialtyCare Credentialing Team

More than 2,000 MSPs gathered recently for the 41st National Association Medical Staff Services (NAMSS) Educational Conference & Exhibition in Colorado Springs. The theme this year, “reach new heights and horizons,” was inspired not only by the locale, but also by the exceptional education opportunities led by the industry’s top leaders.  The event was the perfect run-up to National Medical Staff Services Awareness Week, so I’d like to offer a recap of the conference as we celebrate the team at SpecialtyCare, and their counterparts all across the country, who work hard behind the scenes to ensure patient health and safety.

During the conference, I attended eight educational sessions over a three-day period.  The presentation titled “Legal Update: Legal Developments Affecting Medical Staff Professionals” was extremely interesting.  The speaker, Michael Callahan, JD, discussed several case types impacting hospitals and physicians today:  peer review immunity, peer review protection, Data Bank developments, and peer review damages.  Medical staff professionals need to be aware that most states have peer review immunity statues and provisions, yet some do not (e.g., Florida).  The Health Care Quality Improvement Act is a great immunity provision, however, it does not apply if the lawsuit is specific to discrimination.  As credentialing professionals, we need to be aware of what is in our credentialing file and remove any non-credentialing related documents.  We also need to be mindful that Supreme Court rulings in one state may have impact in other states.

The “Telemedicine and Surrogate Credentialing for Hospitals and Health Systems” presentation resonated with me since SpecialtyCare partners with Remote Neuromonitoring Professionals to provide oversight of our surgical neurophysiologists.  The presenter, Robin Nagele with Post & Schell, shared telemedicine trends, such as the idea that the global telemedicine market is expected to reach $113.1 billion by 2025, up from $2.78 billion in 2016.  She also indicated that more than 65 percent of hospitals have implemented telehealth in at least one care unit.  As we continue to see telemedicine increase in the market, it is critical that hospital bylaws address scope of privileges, categories of privileges and/or membership, responsibilities, and prerogatives.

Most states allow credentialing by proxy, allowing medical staff to rely on credentialing done by a distant-site Medicare participating hospital or by a non-Medicare participating hospital or by an entity that provides contracted services in a manner that enables the hospital to meet all the applicable COPs, or by requiring medical staff to credential each telehealth provider.  The Joint Commission permits credentialing by proxy if the distant site is a Joint Commission accredited organization, and the distant-site practitioner has a license that is issued or recognized by the state in which the patient is receiving telemedicine.

On the last day of the conference, SpecialtyCare Credentialing Supervisor Jessica Campbell and I attended a roundtable networking breakfast.  Tables were arranged to allow stand-alone facilities, hospital networks, payer enrollment groups, children’s hospitals, central verification organizations, and staffing agencies/group practices to discuss significant challenges we currently face. Members of our roundtable shared best practices, including how we manage and justify staffing levels with limited financial resources. Each table was animated with conversation as we collaborated and gained insight that we are all facing similar issues.  It was an opportunity for MSPs to serve and support one another, and band together to achieve new heights and horizons.

I returned to Nashville with a positive outlook and fresh ideas to rejuvenate my department.  I refer to the NAMSS education conference as a credentialing pep rally.  The event brings together a group of men and women who are passionate about what we do.  We are the gatekeepers to patient safety, and I cannot think of a finer group of people who get things done behind the scenes to ensure that our organizations have trained, competent providers and that our patients receive the highest quality of care.