The Three C’s of Credentialing

I am often asked the question…what is credentialing?  I always have a one-word answer.  Verification.  But what do we verify and why?  That’s a better question.  Why do we credential providers?  Now, that will take a blog entry to explain and begins with three words…current clinical competency.  We call these the 3 C’s of credentialing.  And these three C’s are universal to any credentialing model and apply to all licensing and accreditation requirements.

At MPR we have clients across the mid-west with varying licensing and accreditation standards.  Some clients are accredited by The Joint Commission (TJC), while other clients are accredited by the Health Facilities Accreditation Program (HFAP).  There are others such as Det Norske Veritas (DNV) and our ambulatory surgery centers are accredited by the Accreditation Association for Ambulatory Health Care (AAAHC).  Most of our critical access hospitals (CAH) are licensed by the Centers for Medicare & Medicaid Services (CMS).  The common denominator in all these licensing and accreditation requirements is current clinical competency.

At MPR we verify current clinical competence in two different methods:  1) through primary source verification of education and training and 2) through professional peer references. Each verification requires the responding provider/entity to attest to the current clinical competency of the provider in verification of observing, instructing or training. The Joint Commission requires primary source verification of professional and clinical performance that must include peer references and suggest using 6 general competencies for evaluation.  MPR has adopted these 6 general competencies and request them on all our professional peer reference letters.  Another method of providing documentation to prove current clinical competency is the case logs/activity logs of the provider.  These are required for the initial appointment process and the reappointment process as proof of on-going clinical competence.

In the past, hospital affiliation requests were used to verify current clinical competency, but what we are finding is the verification responses have been deduced to form letters stating staff category and beginning and ending dates of appointment.  This is true industry-wide and a true testament to the tremendous workload the medical staff services departments have around the country.

While MPR doesn’t decide what privileges a provider receives at the facility, we are instrumental in providing documentation to assist the facility in making quality decisions about granting clinical privileges. In this series of education blogs I will addressing and defining different elements of the MPR file as we fully address what we do and why we do it.

As always, I welcome your questions and feedback.  So please feel free to join the discussion.

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