Different Credentialing Models for Different Cultures

Sometimes it is hard to admit how long you’ve been doing credentialing.  For me personally, it dates back 20+ years.  Through the years, I’ve seen several credentialing models.  Some have been effective and others have failed.  Credentialing models are primarily created as new information is introduced and made available, for example, the development of the Practitioner Data Bank brought new credentialing models to the surface as the industry explored the impact of information available.  But other models are adopted to survive the reality of doing more with less.  For instance, hospital affiliation letters have changed over the years.  The older credentialing models relied heavily on hospital affiliation letters because they simply reflected how the provider was performing at each hospital.  I remember copying and attaching clinical privilege forms we were using and actually receiving a copy of the clinical privileges the provider held at the hospital providing the verification.  Those days have obviously disappeared as hospitals are required to perform more with restricted hours.  The majority of current hospital affiliations reflect either a referral to the Practitioner Data Bank or provide minimal information of appointment dates and staff category.  The Joint Commission does not require hospital affiliation letters any longer although they can be instrumental in identifying gaps in practice history.

Some hospitals have adopted to accept the AMA physician profile as primary source verification and build information not included on the profile into the credentialing file.  Other profiles include the Federation of State Medical Boards and the AOA Profile for osteopathic physicians.  Regardless of the credentialing model adopted, traditional verification letters are required.   These letters can include (but are never limited to) education, training, work history, hospital affiliation, claims history, professional references, etc.  The list could actually be endless in acquired data verification.  Whatever model is adopted for credentialing, it is important the model reflect the current culture of the facility.  In other words, what is important to the facility or what is important to the credentials committee, the medical executive committee or the governing board.  The key questions to ask in developing a credentialing model include how much information do I want to collect?  Is the information meaningful or meaningless?  How long will it take to verify the data elements required?

Not only do the verification letters need to reflect the current culture of the facility, but the content of the verification letters needs to request specific information needed to meet cultural needs.   Best practices in the credentialing industry reflect professional reference letters that attest to knowledge on 6 different clinical competencies (more to come in a future blog).   In addition, whatever credentialing model is adopted, it should be systematic and routinely applied to all credential files.  The facility should develop credentialing policies and procedures that reflect the facility culture.

The role of MPR is to adopt a credentialing model that is flexible to meet the needs of all our clients and meet specific facility cultural needs/requirements in a timely manner.  This is the goal of MPR and we are committed to meeting the need.

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