National Credentialing Forum 2008 Negligent Credentialing And What

National Credentialing Forum 2008 Negligent Credentialing And What Employers Need to Know to Ensure They Hire the Best Possible Credentialing Staff What do these two things have in common? Lynn Buchanan and Cris Mobley, Discussion Leaders www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process • Non-completion of residency (in specialty other than what privileges were requested) • Question of completion of residency for privileges requested v. last year of residency as house officer (no formal subspecialty fellowship/residency) www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process • Board certification was not ABMS or AOA Board • Note: medical staff bylaws required either completion of residency or board certification without any specificity • Competency letter was copy of letter sent to another hospital years earlier and was provided by applicant; wasn’t “current, ” PSV’d www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process NPDB report was not requested until shortly after the temporary privileges were granted (but before the first patient was seen) • Two malpractice settlements (same as reported on application) NOTE: dr. had add’l claims/ settlements with bankrupted insurance companies – when taken over by state guaranty fund or state insurance company, they don’t always report to NPDB www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process • All current, former state licenses PSV’d with no issues • No issues with DEA • AMA profile not PSV’d with AMA; it was copy • Blanks on application form www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process • Case Outcome – Jury verdict in favor of plaintiff • No monetary settlement HOWEVER, • 100+malpractice lawsuits going forward and will be able to include outcome of temporary privilege verdict (not a class action lawsuit as lawsuits vary in nature for malpractice claims) • No patient deaths • Some claims dropped www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process How did this happen? • First-time CEO • Department chair experienced in leadership role for close to ten years (was scheduled to testify on behalf of hospital until plaintiff atty’s letter suggested he might also be sued along with hospital & dr. ) • He did testify and admitted he didn’t do his job and the medical staff coordinator he relied on didn’t do her job either www. Edge-U-Cate. com

Negligent Credentialing Lawsuit Related to Temporary Privilege Process How could MSC have known? • Medical Staff Coordinator in job by herself for 3 weeks – no previous experience, no formal training • Medical Staff Coordinator did not understand PSV • Medical Staff Coordinator wasn’t trained in “red flag” assessment • Medical Staff Coordinator hadn’t processed temporary privileges before www. Edge-U-Cate. com

Healthcare experts agree that an organization’s credentialing and privilege delineation process is the foundation of quality patient care www. Edge-U-Cate. com

Qualified MSS Professionals What we’re seeing in industry today: #1: Difficulty finding / hiring qualified people #2: Organizations do not see need to hire qualified people www. Edge-U-Cate. com

JOB ADVERTISEMENTS • Director position in northwest healthcare system with 2, 500 medical staff • • Six figure income Advertised nationally approximately 8 months No qualified applicants Position filled internally by director of GME with distant past experience; one manager position filled by another internal candidate from unrelated dept. who considered leaving after 6 months – had no clue what she was in for and no on there to teach her www. Edge-U-Cate. com

JOB ADVERTISEMENTS • Manager position – health system in midwest • Reports to admin dir, patient care services (who reported to VP Pt Care Svcs -previous mgr. reported to CEO) • $70 -$80, 000 starting salary • Advertised nationally for 5 months • Filled by experienced person who relocated and only stayed 6 months • Took 9 months to recruit another individual who had previous hospital experience (but not in last 4 years) www. Edge-U-Cate. com

JOB ADVERTISEMENTS • Medical Staff Coordinator position on west coast, community hospital • $50 -60, 000 • Advertised nationally 9 months, 1 qualified candidate interviewed; offered job, backed out • Filled internally by a finance person • Being mentored by Director www. Edge-U-Cate. com

JOB ADVERTISEMENTS • Medical Staff Coordinator position on west coast • $55, 000 -$60, 000 • Advertised nationally for 5 months; 2 candidates interviewed (no recent full time employment in med staff svcs); 1 offered job but withdrew; position again being advertised www. Edge-U-Cate. com

Why is it so difficult to recruit / retain qualified candidates? • • • Not enough qualified candidates Relocation Salary Automatic exclusion w/o higher education Lack of administrative or MS support and/or needed resources to do a good job • No competency requirements (TJC or HR) www. Edge-U-Cate. com

Why don’t some organizations even look for qualified people? • Do not realize the important role a qualified MSS professional plays in managing and supporting the functions of the medical staff • No industry emphasis on the role MSS professionals play • No competency requirements • Unwilling to pay for expertise www. Edge-U-Cate. com

Ramifications • #1 - Inadequate credentialing can result in poor quality patient care • Joint Commission RFIs • Processes which don’t follow organization’s governing documents • Poor support for Administration & Medical Staff • Negligent credentialing suits ($$) • Negative National Headlines!!! • High Cost of dealing with problem physicians once on staff ($$) • – internal resources, Admin & MS time, attorney fees, fair hearing, www. Edge-U-Cate. com

Some conclusions substantiated by statistics and firsthand knowledge: • The demand is greater than the supply for educated, experienced, knowledgeable medical staff services professionals • Many positions filled internally with no experience/knowledge in this profession • Administrative leadership is often clueless to the need for qualified individuals in these positions • Experience does not necessarily equate to knowledge (competence) • Negative impact on organization www. Edge-U-Cate. com

What do employers need to know to ensure they hire best possible credentialing staff? • #1 – Credentialing is an important function – first step in quality patient care • Administration & Medical Staff rely heavily on MSSP to provide expertise & mgmt. support • Qualified candidates are needed • Qualified candidates expect support & resources to do job. www. Edge-U-Cate. com

What do employers need to know… • If you can’t find qualified candidate: • Hire the right skill-set • Get them the training / resources they need! www. Edge-U-Cate. com

What can we do? • • FOR DISCUSSION How do we focus importance on position? How do we establish competency requirements for industry? How do we cultivate qualified people? How do we provide appropriate training to increase pool of qualified people? www. Edge-U-Cate. com