Best Practice: Credentialing Low-Volume Providers
If a physician in your hospital group does not meet the clinical activity required for re-credentialing, how do you determine his or her competence before assigning privileges?
According to the new Joint Commission standards outlining ongoing professional evaluation, the reappointment process requires much due diligence, including checking licensing, malpractice history, disciplinary action, Medicaid and Medicare sanctions, databank information, criminal history and adherence to professional ethics and standards.
In the past, hospitals also requested staff physicians to whom the re-credentialing physician refers patients, provide letters of recommendation. However, referral relationships raise a conflict-of-interest concern. Moreover, referral letters don’t truly demonstrate the individual’s clinical competency. For that, you must look at the physician’s cases.
Evaluation of cases completed by internal staff and external review organizations often can shed enough light on a physician’s competence to give him or her at least probational status for a procedure. Then the hospital can assign a proctor for a specific number of cases before giving the physician fully approved status.
Because proctoring means two doctors for one procedure, it’s inefficient and impacts the proctor’s ability to make money. Therefore, hospitals should also consider retrospective proctoring as an alternative to monitoring the physician in person. Retrospective proctoring can be done either by a like specialist on staff who has no conflict of interest, or by an external review organization.