Supporting Safer Healthcare

The Ugly Truth About Credentialing and Privileging was recently featured in the May/June 2009 issue of Synergy, the journal of the National Association Medical Staff Services (NAMSS).  Since many people have asked about it, here it is again – enjoy!

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The Ugly Truth About Credentialing & Privileging - Part I

Dear Doctor:

If you’ve been a practicing physician for more than about an hour, chances are you already know the ugly truth. If you’re in medical school or a residency program, odds are good that you don’t have a clue. Not to worry, as a fourteen-year veteran of the credentialing wars, I’m about to enlighten you.

(I feel I must preface this ominous tale with a disclaimer that I am a firm believer in the need for effective, thorough credentialing and privileging – more about that later.)

At last, you’ve completed your training and can begin to practice in your chosen field. You look forward to curing illness, cutting away disease, and finally earning some money so you can start paying back those lovely student loans you’ve accumulated.

Whether you join a large multi-specialty group or bravely hang a solo-practice shingle, you will no doubt need to apply for privileges at one or more hospitals, and perhaps a few ambulatory surgery or urgent care centers as well. If you hope to make even a small dent in those outstanding loans, you’ll also need to join various managed care panels.

How bad can it be, right?

You’re about to find out just how many ways you can be asked to document every place you’ve been, every job, license, certification or board you’ve ever held, whether or not you have any disabilities for which you’ll need accommodation, whether any professional privilege has ever been denied, revoked, limited or suspended, and whether to the best of your knowledge anyone is even thinking about denying, revoking, limiting or suspending anything of yours.

You’ll also need to produce the names, addresses, phone, and fax numbers of various individuals who will serve as your references. Some you’ll get to select, others may be prescribed. If you apply to a number of organizations all at once the people you name will get the joy of responding to multiple requests. If they don’t answer in a timely fashion you’ll be given the opportunity to prod them along. You may want to practice groveling, as nothing delays privilege approval quite as effectively as references who fail to respond.

Getting the picture? Verification of credentials is a huge, time-consuming, pain in the neck. Establishing that you’re currently competent to request and perform a vast array of delineated privileges only adds to the discomfort.

Unlike fine wine, the process does not become more palatable with age. The longer you’ve been in practice the more years of experience there are to verify, and the more proof you’ll need to produce to show that you’re still proficient at the ‘otomy, ‘ectomy and ‘ostomy that you learned way back in training.

There’s more, but I don’t want to discourage you overmuch with too many dark, dire warnings of a future decorated in red tape and dominated by writer’s cramp. (And we haven’t even touched on medical records documentation!)

Take heart – I have some tips to share on ways to make the credentialing process a slightly less bitter pill to swallow, so continue reading “The Ugly Truth – Part II“ to get your next dose of “Realdox.”

The Ugly Truth About Credentialing & Privileging - Part II

In Part I of this lesson you learned that the credentialing/privileging process is deep, dark, and sometimes painful.
 
The Purpose of Part II is to show you that there can indeed be light at the end of the tunnel.  If you fill out your application honestly and carefully, that light at the end of the tunnel will likely lead you straight to privileges, patients, and prosperity (well, privileges and patients anyway.) If however, you’ve tried to pull the wool over the eyes of your intrepid medical staff service professional and medical staff leaders by not revealing the truth, the whole truth, and  nothing but the truth, well, let’s just say there may be something far heavier heading your way at the end of that tunnel.   

I have a few simple tips to share with physicians and other providers who apply for hospital privileges.  Most of these tips will also work well if you’re applying for privileges at another type of healthcare organization, or for membership on a managed care panel.

Top Ten Things Physicians Do To Derail The Application Process:

• 10. Write illegibly
• 9. Leave numerous areas of the application blank with “see CV” scrawled across the page
• 8. Shave a few years off your date of birth.  Who’s going to notice, right?
• 7. Refuse to give your social security number, date of birth, year of medical school graduation etc., and write “none of your business” on the application.
• 6. Fail to include requested supporting documents.
• 5. Guess at your dates of medical school graduation, residency completion, etc.
• 4. List your parents as professional references.  After all, if Mom thinks you’re a good doctor, you must be okay.
• 3. List professional references who cannot, do not, will not, respond to our requests for information. 
• 2. Forget to mention that you were named in one or more malpractice actions, lost one or more medical licenses, had one or more institutions revoke your privileges, etc.
• 1. Give your name as Michael Swango, M.D.  (If by unfortunate chance that really is your name, considering going into another line of work.)

And now, for a bit of detail:

Number 10 – Write illegibly
You may think that if you write illegibly no one can accuse you of not answering accurately.  Here’s the scoop.  We who work in the world of credentialing generally have way more things to do than time to do them.  That means that if you attempt to make us decipher terrible handwriting on your application you are likely to either A) get the thing back with a request that it be redone, or B) find that your application consistently gets shuffled to the bottom of our stack while we work on the ones we actually can read.

Number 9 – Write See CV
While writing “see CV” works on many applications, it is unacceptable on an application for medical staff membership and privileges.  At the end of your application you will be asked to sign a statement that says something along the lines of “I swear that everything I’ve written down here is true to the best of my knowledge.”  Courts have been less than inclined to accept “see CV” as a fulfillment of that statement.   Keep writing.

Number 8 – Shave a few years off your date of birth
We check.  If the DOB you give us doesn’t match up to the one on your records, we figure that either A) you have such a bad memory for detail that your ability to practice medicine must be questioned, or B) you don’t ascribe to that “honesty is the best policy” tenet, which makes us wonder what else you’ll lie to us about. 

Number 7 – Write “none of your business” on your application
Sorry, if we’re going to entrust our patient’s, friend’s, and family’s lives to you, it is our business.  Health care providers do have to supply a considerable amount of personal information in order to get membership and privileges.  Your patients don’t have a right to ask, but they trust that we have, and that we’ve gotten the answers.  We take that trust seriously.

Number 6 – Don’t send requested documents
Without copies of the requested documents your application is incomplete.  Incomplete = no privileges.  Which means of course, that as you collect those various documents over the years, keep them in an easy to locate file, it will make all of our lives simpler.

Number 5 – Guess at dates
If you tell us that you graduated from medical school in 1983, but the medical school says you graduated in 1985, we get very suspicious.  (As you may have guessed, having a suspicious mind is a job requirement for my line of work.)  We wonder, do you not remember when you graduated?  Refer back to conclusions A and B in statement #8.

Number 4 – List relatives as references
We’re really glad your parents (aunts, uncles, siblings, etc.) like you.  Happy families make for happy doctors.  Relative references however make us wonder if A) anybody who actually works with you likes you, and B) whether your relatives might be influenced by the hope that you get a job and pay back all the money they loaned you while you were in medical school.  Avoid references with obvious conflict of interest issues.

Number 3 – List professional references who don’t respond
Admittedly you may not know this about these people at first.  However, in cases where you have a choice about who to list (as opposed to tell us the name of your last program director) give us people to contact who will actually respond.  It is very helpful if you tell them you’ve submitted an application with their name listed, and ask them to please return the requested reference as soon as possible. This is often our number one hold-up in moving an application through the process.

Number 2 – “Forget” to mention something adverse
We check.  Chances are quite high that we will uncover whatever you haven’t told us.  Adverse events in your history MAY keep you from being granted privileges.  Lying about or omitting adverse events will almost ALWAYS keep you from being granted privileges.  It could also cause a denial or revocation of membership and privileges, which may result in a report being filed about you with the National Practitioner Data Bank.  You’ve spent so much time, energy, and money training to be a physician; don’t throw it away by lying to us.

Number 1 – Be Michael Swango
If you’ve never read the book “Blind Eye – How the medical establishment let a doctor get away with murder” by James Stewart, pick up a copy.  It’s the story of MD serial killer Michael Swango.

It will help you understand why Medical Staff Service Professionals, as well as Credentials Committee, Medical Executive Committee and Board members tend to be so paranoid and picky.  None of us want to look into the eyes of a grieving family member and say, “We just didn’t know.” 

It’s our job to know.  And it’s your job to help us.