Medical Credentialing - A Broken System

I was recently introduced to a Chief Medical Officer who opened our conversation with, "As far as I'm concerned the medical credentialing system in this country is broken."

My response?  "You'll get no argument out of me."

In this age of global communication and technology why must we gather, validate, and store the same information on the same individuals repeatedly, (and often simultaneously to one or more of our colleagues)?  Law, interpretive guidelines, and accreditation standards mandate some of the redundancy, but as the healthcare system's credentialing experts, do we allow habit and fear to block our minds to the exploration and development of new concepts?

Something to consider.

Great things are done by people who think great thoughts and then go out into the world to make their dreams come true.

Comments

[Kathy Matzka]

I don't know if the system is broken, or if it just never really worked well to begin with. Verification of credentials, while duplicative and time consuming, is not a difficult task. What is difficult is verification of competency.

At a recent lecture I attended, a hospital attorney speaking on negligent credentialing stated that she always advises that hospitals NOT share performance improvement or peer review data regardless of whether or not the hospital received a consent and release form signed by the physician in question. Her reason was that she feared that the physician would sue the hospital for sharing the information. Peer review statues and the Healthcare Quality Improvement Act (HCQIA) do not protect hospitals from these suits.

What I feel we need is an amendment to the HCQIA that allows protection for healthcare entities when sharing peer review and performance improvement information with other healthcare entities. In fact -- to go out on a limb -- I feel that the HCQIA should not only be changed to include this protection, but also to include penalties for healthcare organizations that do not share peer review information that resulted in a negative recommendation or in which the provider was found to be at fault.

At the 2005 national conference for the National Association Medical Staff Services, Dr. Robert Wise from the JCAHO asked a question to approximately 500 medical services professionals regarding how many of them had a physician on their medical staff who should not have the privileges they were granted, and over half of the people raised their hands.

A 2006 study on Patient Trust and Safety by the American College of Physician Executives showed that 77% of the physicians interviewed said that there is a doctor in their community they would avoid because they felt that the doctor made medical errors. Check it out at www.acpenet.org/MembersOnly/pejournal/2006/March_April/Articles/2Weber.pdf

Hospitals and medical staffs do not like to take action against a provider. Until we have adequate protections and requirements built into the laws, I don’t see that there will ever be a free sharing of this information.

[Aggravated DocSurg]

I agree -- the current system is not one that provides for the best possible care to be delivered at each institution. However, despite the original intent of the privileging process, it has never been one that would be up to that task. Our current system is designed to prevent hospitals, hospital boards, and physicians on peer review committees from being sued (see what happened at Presbyterian Hospital in Dallas recently).

And that, while sad/ridiculous/disingenuous/etc., is a reflection of the tort system we live in.

[Barbara Blackmond]

I believe that the HCQIA and most state laws do protect hospitals that respond candidly to other hospitals' requests for information. The HCQIA provides for two different immunities, one for those who serve on committees and those who "provide information" - the latter is not as well known, but it provides immunity unless they provide knowingly false information. Is it enough? No, but I doubt Congress would ever enact legislation preventing suits... There are still many who continue to decry what they call "sham peer review" (which I do not believe is rampant! In my experience, most Medical Staff leaders do an incredible job trying to be fair!) The Kadlec case will likely contribute to more candid responses, or at least promote the use of "flags" (such as a request for a specific release) that will prompt more questions and the application can be held incomplete until the applicant provides all information or goes away.

[Rita Schwab]

Great discussion. For those of you following this thread, see what Aggravated DocSurg has added here: Medical Staff Credentialing - Part The First to which I appended the following comment:
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First off, I like this discussion. This is an issue worth dissecting.

I've met the somewhat bumbling average resident you describe - more than once. And you're absolutely correct - many average Joes can become stellar performers with a bit of mentoring and guidance. Unfortunately, established physicians who do not work with formal programs in teaching hospitals are often afraid to put their own practices at potential legal risk in order to mentor the new kid. I suspect that this is a case of "fear making the wolf bigger than he is," but the "wolf" of potential litigation does indeed prowl just outside the door.

Medical staff credentialers are committed to protecting patients and our institutions. Valid, noble concerns.

Slightly lower, but still in view, is an interest in protecting our medical staff members. I have sat with angry, frightened physicians and shared their pain at being sucked into a scary legal vortex. Over the years I've also met those who call themselves doctor but whose primary concern is acquiring money and making a name for themselves. To these "docs" patients are simply an inconvenience standing between them and a dollar.

Yes, we need good doctors, but we also need good lawyers. I've known a few of those over the years as well.
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[Alfreda Doonkeen]

My education bacground was credentialed while I was on medical leave. The letters sent to the undergraduate/graduate schools stated 'I' gave the permission.

I did not. Is this illegal? (to pretend?)