The Cost of Doing Business BRAINSTORMING DOCUMENT for NCF Prepared by Bonnie Conley, CPCS Director, Medical Staff Services Trinity Medical Center

MISSION The Credentialing Forum emerged from a group of medical societies who first met in 1995 with the mission of reducing health care costs, decreasing duplication, simplifying the credentialing process and improving the efficiency of health care delivery. Their first accomplishment was the development of the Core Credentials Verification Tool. As basic work on the tool was completed it was agreed that the benefit of a national forum to bring together all organizations interested in credential verification was unique, valuable and should be continued in some form. 14 years later …………THE NCF DISCUSSES AT EACH MEETING WHAT IS OUR FUTURE. I hope today that I can provide some ideas for that future.

Problem: Our own industry. MSSP Industry Standard –Our own interpretation is one of the problems: When asked why we verify something I have heard these comments amongst my peers –EXAMPLES: Because we have always done that Because that is what the standard says Because that is what XYZ hospital does I heard it at a conference Because a surveyor said so Contractual terms with the government

Problem: Accrediting Bodies standards are not prescriptive or misinterpretation of the MSP or National Firms that influence the MSP –An example of this is follows

EXAMPLE -Standards Example – this FAQ was on the TJC website regarding work history - Verifying Work Experience Q: Is there a time limit as to how far back a practitioner's work experience must be verified? A: No. The standards require verification of relevant work experience. The organization is required to make a reasonable attempt to verify all work experience that is relevant to the privileges being requested. In many cases this may be many years ago if the practitioner has been in practice for a long period of time. What is the relevance of work history that occurred 10 years ago? Do we have the luxury of each hospital expending valuable healthcare dollars to find that one person out of thousands of good physicians that made someone mad 10 years ago and now we have a negative reference and no can even remember the incident? Shouldn’t we spend money on assuring that current competence is being monitored and evaluated not something that happened 10 years ago. Aren’t other points in the process before they get to our hospital, like board certification and licensure enough of a screen to put some parameters around the timeframe of this and other less informative elements?

Another Problem There is no exchange of quality information between hospitals

Problem: Static Information and use of Profiles and CVO’s This is the key to saving across the board. Every hospital/healthcare entity verifies medical school and residency program, information that does not change every time an applicant applies somewhere new –The concept of CVO’s and the AMA/AOA profiles are good but have not been fully embraced by our industry. In a perfect world could the medical schools and residency programs report into a data bank that we could query for this information. The information will always be fresh and an evaluation could be put on file at the time of completion

Love OPPE and FPPE Now let’s eliminate reappointment and really save some money !!! Or as I heard yesterday extend to three years. There is not enough time or staff to work on what is important (Implementation of robust OPPE and FPPE requirements, etc NOT TO MENTION PRIVILEGING.) because we are chasing the same old paperwork that adds no value to the decision that needs to be made

Technology In line with JC recent Sentinel Alert on the need for up-to-date technology in patient care settings. This is true also for the link to patient safety and the cost savings in administrative areas of the hospital that can also be realized through technology. How can we get that point across ??

Recommendation Therefore, today I am challenging the NCF to return to their mission and use the overwhelming expertise that is around the room do something for our industry that will truly save healthcare dollars and give us a valuable tool.. I suggest that a position paper be authored in collaboration with all the industry experts that attend this forum. The paper would be endorsed by TJC, DNV, CMS and legal counsel The position paper would distill all myths from every angle about what is required to produce a quality credential file that would document a practitioners ability to join the medical staff and his skill and ability to perform the privileges requested today The NCF could leave their mark on our industry with such a position position, help to strengthen alliances, could impact legislation and with all agendas aside make a real difference in cost savings for every hospital in our nation and each of us would return from this meeting to a process that is in a better place today than when we found it 14 years ago