Medical Staff Credentialing and Privileging,Medical Protective Clinical Risk Management Department;

Medical Staff Credentialing and Privileging Medical Protective Clinical Risk Management Department; DR FIAZ MAQBOOL FAZILI(CLINICAL AUDITOR,CHIEF INVESTIGATOR ON MEDICAL MALPRACTICE CASES; EX DIRECTOR QPS &Q A (QUALITY AND PATIENT SAFETY AND RIGHTS ) High on hysterectomies: Losing wombs to medical malpractice-Medical practice has been on news for most of the times due to wrong reasons.(usually one side of story is published without any explanation from the other party Is there any accountability or supervision in our healthcare system.Who can do what? …Needs Credentialing and privileging. - How important it is to introduce CREDENTIALING AND PRIVILEGING process and implement it strictly in our ailing (unaccountable healthcare delivery system? Healthcare organizations are responsible for validating the competency of their medical staffs through credentialing and privileging. Who can perform what?Is having qualification certificate enough to do all types of procedures even within the certification of speciality ot outside the speciality he or she is qualified . ,whether a person has really performed actually this operation or intervention .Is it recorded,number safety- undersupervision; supervised(proctoring ). (e.g all general surgeons cant perform; whipple procedure; portocaval shunts; ) Where is log book?—A personal record of Medical professional from minor iv insertion yo major surgery )each specialty has its list of privileges,each procedure,intervention is attested ,authenticated by team of experts about the said professional; whether he or she is authorized to do procedure independently and safely,proctoring or under supervision, or just an assistant or observer. Oversight of the quality of care provided to patients through the process of credentialing and clinical privileging is a core fiduciary duty of hospital governing bodies Fiduciary and legal duties. The companion piece to credentialing is “privileging,” which is the process of authorizing a licensed or certified healthcare practitioner’s specific scope of patient care services. Privileging is performed in conjunction with an evaluation of an individual’s clinical qualifications and/or performance. In the past, credentialing and privileging were mainly associated with hospitals. Now, these processes are required at healthcare facilities, ambulatory surgical centers, and long-term care organization Negligent credentialing claims. Risk managers should be aware that many jurisdictions recognize a cause of action against hospitals for negligent credentialing. In those states, nearly every claim for serious patient harm or injury arising from care provided in a hospital by a physician with medical staff privileges may result in plaintiff's counsel scrutinizing the hospital's credentialing and privileging processes .Negligent credentialing claims brought by or on behalf of injured patients typically allege that the hospital's negligence in credentialing or privileging a physician caused or contributed to the person's injury. Such claims focus on issues implicating the hospital's credentialing procedures and peer review processes, as well as compliance with regulatory requirements and accreditation standards. Adverse credentialing decisions. Furthermore, an aggrieved physician may challenge a hospital's adverse credentialing decision through the facility's fair hearing and appeals process, or through litigation alleging violations of antidiscrimination laws or failure to meet standards established under the Health Care Quality Improvement Act Credentialing is “the process of assessing and confirming the qualifications of a licensed or certified health care practitioner.” Credentialing is an essential process that healthcare organizations and practices must perform to ensure those providing services are qualified to do so. Credentialing is the process through which physicians provide their credentials for review, assessment, and recommendation to the hospital's governing board. Hospital boards approve or deny medical staff appointments and reappointments and grant, deny, expand, restrict, or suspend clinical privileges after considering recommendations made by the medical staff. Employing credentialing and privileging processes, hospitals act as gatekeepers, safeguarding patients from incompetent and dangerous healthcare practitioners. Privileging is "the process of authorizing a health care practitioner's specific scope and content of patient care service? PRIVILEGING REQUIREMENTS (INITIAL AND ONGOING) Organizations should have clearly defined processes to determine whether sufficient clinical performance information is available to make a decision to grant, limit, or deny privileges requested by a practitioner. Privileging of each licensed or certified healthcare practitioner should be specific to each of the healthcare organization’s care delivery settings. (For example, performing a procedure in a hospital setting might involve a different level of risk than in an office setting.) Considering the care delivery setting is particularly important for managing risk within a healthcare network or among hospital-owned physician practices. Information regarding each practitioner’s scope of privileges should be updated when changes in scope occur. Privilege information should be readily available to all who might need to know the status. This might include making the information available on the organization’s computer system, so that appropriate departments and staff have the ability to review the materials when necessary. The decision to grant, limit, or deny an initial request for, or renewal of, privileges should be communicated to the requesting practitioner within the timeframe specified in medical staff bylaws or office policy. This information should also be disseminated and made available to all appropriate internal or external persons or entities (as defined by the bylaws or policy). The healthcare organization should have a fair hearing and appeal process for practitioners who are denied one or more clinical privileges. PROFESSIONAL PRACTICE EVALUATION MONITORING It is recommended that new medical staff members and those who have newly granted privileges undergo a performance monitoring or proctoring period. As part of a performance monitoring process, organizations should consider: • Identifying specific evaluation criteria; • Determining an appropriate monitoring plan; • Deciding an appropriate timeframe for monitoring; and • Identifying any circumstances that require monitoring by an external source. Process for performance evaluation and monitoring. Focused Professional Practice Evaluation; Focused professional practice evaluation (FPPE) is a process used to confirm a practitioner's current competence at the time new privileges are granted, either at initial appointment or as a current member of the medical staff. FPPE has more frequent and intense monitoring than Ongoing Practice Performance Evaluation (OPPE; see below). Proctors, or reviewers, who evaluate a healthcare provider should be appointed based on criteria determined by the organization's medical staff. Ongoing Practice Performance Evaluation OPPE begins when competency is established. This process includes the ongoing assessment of an existing medical staff member’s performance. The organization’s bylaws or policies should identify which members of the medical staff will have primary oversight of this performance evaluation process. Healthcare organizations are responsible for validating the competency of their medical staffs through credentialing and privileging. These processes are closely tied to reimbursement, accreditation standards, and state and federal laws. Although credentials and privileges will vary among providers (depending on their backgrounds, qualifications, areas of practice, and practice settings), having detailed and consistent credentialing and privileging processes is imperative. Further, organizations should consider establishing thorough performance monitoring processes to evaluate practitioner competency at initial appointment and over time. Thus, it behooves risk managers to view the organization's credentialing and privileging process from a risk management as well as a patient safety perspective. By working in coordination with the facility's medical staff credentialing director or coordinator and the facility's legal counsel, risk managers can ensure that the facility's credentialing process meets legal and regulatory requirements, as well as applicable accreditation standards, thus facilitating patient safety. LEGAL STANDING OF CONSENT; 1Consent given only for a diagnostic procedure, cannot be considered as consent for therapeutic treatment. Consent given for a specific treatment procedure will not be valid for conducting some other treatment procedure. 2.The fact that the unauthorized additional surgery is beneficial to the patient, or that it would save considerable time and expense to the patient, or would relieve the patient from pain and suffering in future, are not grounds of defence in an action in tort for negligence or assault and battery. 3.The only exception to this rule is where the additional procedure though unauthorized, is necessary in order to save the life or preserve the health of the patient and it would be unreasonable to delay such unauthorized procedure until patient regains consciousness and takes a decision (iv) There can be a common consent for diagnostic and operative procedures where they are contemplated. There can also be a common consent for a particular surgical procedure and an additional or further procedure that may become necessary during the course of surgery. (v) The nature and extent of information to be furnished by the doctor to the patient to secure the consent need not be of the stringent and high degree mentioned in Canterbury but should be of the extent which is accepted as normal and proper by a body of medical men skilled and experienced in the particular field. It will depend upon the physical and mental condition of the patient, the nature of treatment, and the risk and consequences attached to the treatment. DISCLAIMER . This guidance article provides an overview of the process for credentialing and privileging of practitioners and discusses the role of risk management in minimizing potential liabilities associated with this process. It discusses aspects of federal and state,not as a replacement for legal reference authentic source. Dr.Fiaz Maqbool Fazili MBBS; MS(SKIMS);FICS;FICA(USA) MAMS;DTQM; CQPH;FISQua;CTQM;(Q&A) Senior Consultant Surgeon (General & MAS)Surgical Gastroenterologist . Ex Consultant Surgery SKIMS Soura. President WALS(World association Of Laparoscopy Surgeons -KSA) CQPH .Certified Quality Professional (Specialist in Healthcare quality and Accreditation of Hospitals). Ex.Director TQM & QPS. Policy planning and Operations, Healthcare Standards and Patient Care improvement, Quality management ,Patient experience;Helps hospitals to prepare to achieve NABH/JCI /CBAHI Accreditation Clinical auditor & Expert in Hospital building & Healthcare Planning; QPS-Quality care and Patient safety; Strategic operations ;Patient care improvement ,safety (Patient experience);Advisor/counselor on Patient Family rights(medical malpractice complaints) ; Disaster Management.