Recording of Proceedings
Holiday Inn on the Bay, San Diego
February 2 – 3, 2012
WELCOME/HISTORY NCF: Facilitator, Annette Gippe
Local Host, Maggie Palmer
INTRODUCTIONS: Multivariate and interesting. Best quote:
“I do not want to be just a “networker”, but a “Connector” – there will be “no break in what we do.” (Maggie Palmer)
WHIP-AROUND NON-PRESENTERS:
· MSPs (Medical Services Professionals) are less engaged in process of survey – offered to TJC as perspective from industry.
· “Smarter” collection of data. Hospitals are rich source of collection of data. Build community of “safe sharing”
· Verification of competence for “scope of care”
· Support of emergency response members web services by creation of universal piece to interfaces – web services integration to connect all the pieces,
· Board Certified Docs is enhancing data elements to make things easier/simpler. ABMS directory will become electronic this year (not a credentialing product). There is still use of “compendium” to see who is certified.
· ABMS improving communication with diplomats to make data less confusing
· ABMS new CEO 2012; looking to boost certification to international circles
· Pilot program ABMS: MOC – Building standards
· Reduction in costs + Increasing efficiencies = with no effect on quality; new initiatives / career paths for MSSPs
· Industry observations: more emphasis on advanced professional’s roles expanding dramatically; added options of accreditors on the rise; contract/employee/medical staff changes
· MSSPs still ineffective – some embracing new technology and methodology but holding on to the past as well; Edge-U-Cate – still offering week long Credentialing Schools for those new to hospital, ambulatory/managed care and one Beyond course
· Administrative leaders in hospitals and MCOs do not understand importance of credentialing
· Nemours: Challenges post Delaware’s Dr. Earl Bradley Case (note case on Internet). Diminished peer reviews, diminished medical staff role in reporting physicians, diminished policing self.
· Nemours is largest pediatric facility in country and building a Children’s Hospital in Florida from ground up.
· Electronic health records enhance patient safety however internet access at any work station begs the question how to protect patient information.
· Toyota Lean process
· ECFMG: certifies 10,000 IMG’s per year. January 2012 PSV for undergrad’s is now completely electronic. Will have electronic portfolio of International Graduate’s credentials (foreign medical school, foreign post-graduate education, and foreign licensure). Twenty-five percent of practicing physicians and residents are foreign graduates. There are 2200 foreign medical schools. ECFMG will PSV through international credentialing services.
· There are 375,000 Board Certified physicians meeting the requirements of MOC. What happens with those who do not keep up with MOC? Very onerous and costly task. What to do with specialty designations when there is no board? How do you justify as a referral designation?
· Give people tools then need to do this work. People should not spend their time doing things technology can do for them. Credentialing “folklore” out there in great numbers that don’t contribute to value of process.
· Evolving structure complexity – sharing of information across departments (HR/Med Staff) impacting role of MEC and what they are in charge of
· How CME has changed – has pendulum swung too far? Where is assurance of quality – burdensome on both ends (MD and provider of CME)
· VAH Administration struggles in rural health care an issue; others have trouble with recruiting. Quality issues even greater (in recruitment and in data – no infrastructure to manage it)
HFAP – Joe Cappiello: An accreditor can be a facilitator of credentialing goals. Struggle: laying foundational framework to “do right thing” – Risk Reduction Strategy Guidelines: if you are in compliance, likelihood that bad events will diminish. Consultants are paid to “pull up rocks, lift curtains, and put hands in mucky water” looking for compliance with standards. Mission: is to increase awareness among Medical Centers in USA that HFAP exists as an accreditation option. HFAP standards are primarily based on CMS CoPs. Facilities do not need to be an Osteopathic hospital for HFAP certification.
· PSV – accreditation organizations employ humans so there is a margin for error. HFAP/paper copies not needed, just assurance there is a process on site and it is complete and consistent. No requirement for screen shot of verification.
· OPPE – Data requires onsite information on provider experience at that organization; what if going externally for Low Volume? How do you know it is good data? Do a FFPE if/when provider is in house.
· Membership vs. Privileges – Phase II or looking at skill sets and maintenance of skills. If not maintaining skills, then membership without privileges is fine to keep physicians connected with organization on some level.
NCQA – Gerald Stewart: Healthplans have qualified providers in their networks. Credentialing and Privileging Standards for MD, DO, DPM, and behavioral have not changed for a long time. What’s new: expansion of type of practitioner to profile – NPs, LIPs, and PTs; provider’s not needing supervision. Question: what if practitioner was not practicing independently – Answer: then not necessary. New standards being proposed – information will be out in February for public review. Customers are requesting if NCQA requires organizations to make decisions within defined timeframe. UMCR (Utilization Management Credentialing) replacing POCs (Physician Organizations). ABPS (American Board of Physician Specialties) not recognized board as of yet: Not a designated equivalent for ABMS or AOA. VA states they verify whatever certificate is submitted to organization, however not all are recognized for privileging purposes. Hot issue: Certifications from National Boards.
The Joint Commission – Larry Kachik, MD: Value for clients: Where we are in “real time” not the future… this is about ‘risk reduction’. TJC is there to point out risks. Much improvement over the years has been seen in centralized credentialing and electronic files. Privileging piece: TJC does not have real data about competency of providers. OPPE/FPPE must be meaningfully assessed and measured: increased satisfaction and decreased bad outcomes. Must plan, get people, communicate what to do, what to collect, and change performance. Perfunctory data out there but doesn’t move the bar towards quality. Some programs are so labor intensive they do not get finished. A successful organization has committed leadership and medical staff with resources and dedication to principles. Board members understand what accountability to quality, do not rubber stamp quality reports, communicate well, and equip staff to complete task. Does Board have enough MSSPs, Quality, and others to get the job done well?
· Data – are indicators meaningful
· Data economy – how much does it cost to produce data
· ICD9 codes linked with privileges (what they do vs. what they say they do)
· Does OPPE drive FFPE
· Good organizations monitor appropriateness of care, Department Chairs should carefully look for outliers
· OPPE/FPPE for NPs and PAs are difficult to perform but need a plan: Possibly look at care early, not waiting for lapse of six months to review charts.
High performer OPPE/FFPE:
· Committed Medical Staff demand high performance
· Meaningful indicators approved data collection (inexpensive)
· Review data on ongoing basis (real time) and who is going to dissect and report it
· Align Quality and Medical Staffs
· Meaningful volume data of each practitioner
· Non-biased review of new practitioners for track record FFPE
· Act on data, with well defined triggers
In 2012 OPPE/FPPE process will be further reviewed. Future: How to possibly marry FPPE/OPPE and ABMS; and question of privileging RNFAs.
URAC – Carole Crawford: Does not require screen print of license, although they are nice to see because you can see the URL and date PSV information was accessed. URAC assesses continued competence by onsite monitoring surprise visits. There can be 3 day or 3 minute notice; complaint prompts are unannounced. URAC is checking for compliance to own processes. Use of electronic data is good. Completes surveys on laptops. There are no new standards; however, the expansion on delegation of oversight (portions of credentialing) has been beefed up. Question whether there should be standards for MSPs? (NAMSS will send proposed language for MSP standards to TJC and HFAP). Value: Credentialing/privileging is complicated process needing experienced professionals at helm.
Discussion: Taking Down the Shingle – Carol Cairns: Aging physicians is a very political issue:ABMS: does not have an official position in regard to certification process. Recertification/MOC continuous modules keeping up with skills, MOC will decrease lifetime certificate holders. There are 375,000 Board Certified physicians, with an increase of 50,000 per year.
FSMB: MOC of licensure will discuss reentries of practice. Economic changes where formerly retired MDs are attempting to reenter practice. FSMB will work with constituents on issue.
Nemours: Executive VP of patient operations recognizes physicians with difficulties related to aging or other issues. ADA versus competency; age/illness/life stress/involvement in bad-outcome cases -merged into ongoing process. Triggers increase with age (or could be applied at any time) to decrease discrimination.
VA Update – Kate Enchelmayer: VetPro – new service request 2009 IT partially support. Separate out appeals process:
· Self-registration
· Requirement defined for privilege module to tie into credentialing module
· Building red flag alerts (DEA, license, NPDB, etc.)
· Technology force comments by reviewers
· Other Federal agency MOUs (DoD) – sharing of credentials
· TJC: HCP must be credentialed to do disability exams for military returning from theatre.
· Training lab: Credentialing BootCamp (to handle 30-40 MSPs several times a year)
· Allied and mid-level practitioner – APRNs work to level of licensure; allow by policy all NPs to work independently regardless of state licensure. They are tagged as LPPIs (Licensed Practitioner Practicing Independently). Complexity of patients: APRNs care for less ill patients, order more exams, difference in skills, knowledge, and competency. Panels will be smaller than physicians.
· Approximately 36,000 physicians and 250,000 healthcare workers in VAH system
· DoD privileges everyone – they are different than VA. Providers are variant:
o At Will – there is no process
o Probationary – some process
§ Is it Peer Conduct – Human Resources
§ Is it Competency – Medical Staff
§ Is it Both – Arm and Arm (HR & MS)
o Permanent:
NAMSS – Connie Riedel: Annual conference (36th anniversary) is in San Francisco on Sept. 4-8; 2013 is in Hollywood, FL; 2014 is in New Orleans. Partnerships and alliances were listed and a report on meetings with some of these groups. There has been strategic planning in areas of membership, technology, governance, and strategic alliances. Task force to increase membership with managed care professionals. Educate/guide membership through transformation of profession:
· Membership – growth and education
· Technology – Maximize for successful communication
· Governance – overhaul to ensure volunteer sources are used effective (SMEs)
Flashes of Brilliance “Out of the Box” Ideas Breakout Groups:1) Think bigger, be bolder - Federalize license to practice; pay portion of funds to states where they practice. Ongoing clinical competency, where to get info and make it reliable. EMRs could be vehicle to collect physician attribution and collect info as a bi-product of care. NCF could approach a couple of major EMR vendors and get them as structured part of project to talk with organizations to be sure to engineer their screens to collect quality data as bi-product of care. Are doing it with core measures but should be expanded.
2) Physician practitioner applications; practitioners allow their reappointment to run out or resign without reportable results. Could NPDB list who is querying the applicant? (NPDB discloses to practitioner who queries them). Organizations could have physician self query.
3) National Standard where static documents are standardized, waste eliminated, (state/national platform of uploaded data fields); want national reporting of quality statistics but no real recommendations at this time.
4) Put together education about importance of what “we” do (credentialing industry) – how/why important. White paper from group? Qualification assessment management v. credentialing – change name? Reach out to HR groups to develop job description/qualifications for this title. Are there any “qualms” about this provider? MOC for MSSPs; letters from CEO or someone to verify compliance.
DAY TWO: NCF 2012
Current Initiatives to Streamline Process and Discussion: State Licensing Boards:
The Joint Commission – Carol Ptasinski:
· Periodic performance review self-assessment: determination of problem.
· Inter-cycle monitoring process – occurs 12 and 24 months after survey (survey is every 3 years); surveyors will be included on call.
· SGS (ISO certifier) partnering/collaboration for quality-management component
FSMB – Sandra Waters: FSMB has 70 Member Boards (House of Delegate), under which are the Board of Directors and Executive Office. There is a new vision/mission on FSMB website. FSMB provides (Slides Available on NCF website):
· Assessment tools
· Co-owns USMLE / offers comprehensive review of USMLE
· Post-Licensure Assessment
· SPEX – multipurpose exams (e.g. reenter practice)
· PLAS – specialized assessment
Other projects: Looking at physician license portability for underserved. How should it occur with concurrent protection of public? Include adoption of uniform application to reduce administrative burden for physicians. Linked to FCVS (PSV of Core credentials); regular communication with Boards, submitted in October NCQA Certification of CVO (FCVS).
Telemedicine: FSMB is committed to state licensure, ensuring quality – license piece must be thought through first.
Committees: Reentry to Practice (2011-12)
Ethics and Professionalism (2011-12)
FSMB Advisory Council/Panels:
· Advisory Council of Board Executives
· Centennial Advisory Panel (2012 – check website for details)
· SMB Advisory Panel to USMLE
· MOL Implementation Workgroup
· MOL Workgroup for non-clinical physicians
· Telemedicine Workgroup
FSMB Centennial August 2012 – check website, please come to celebration!
Office in DC – closer to legislative happenings