1. the right care in the right place at the right time Credentialing and Privileging for Telemedicine Providers Miles S. Ellenby, MD Associate Professor Pediatrics & Anesthesia Medical Director, Telemedicine Program

2. Definition History Practicalities Senate Bill 569 Credentialing – An Overview

3. Hospitals have a legal duty to evaluate the competency of physicians who administer health care services to their patients Hospitals evaluate & verify the qualifications of healthcare providers to ensure that practitioner possess the necessary qualifications to provide services to patients Once credentialed, further steps re practitioner’s competence in a specific area of care, through process known as privileging Credentialing – A Definition

4. ~1000 BC – Persian religion of Zoraster –outlined the process for physician “licensure” –to earn the right to practice medicine a candidate had to prove himself by successfully treating 3 heretics –if all 3 lived, he was considered fit to practice medicine for “ever and ever” –if all 3 died, he was denied the right to practice medicine –From Vendidad, a book of religious law Credentialing – History A very brief history of credentialing From the May ACP Hospitalist, 2009 By Elizabeth Scoville and James S. Newman, FACP

5. 1140 Sicily – King Roger II – the first “Boards” Mandated anyone who had not passed an examination would be forbidden to practice medicine 1224 – his grandson, Frederick II – prerequisites Expanded declaration by setting up specific guidelines to obtain a medical license, requiring study of: –logic for three years –medicine and surgery for five years –practice under an experienced physician for one year –After completing these requirements, a candidate had to be examined in public and approved by a group of master physicians So effective in reducing number of sham physicians, similar laws were implemented in Spain and Germany Credentialing – History

6. Theodoric of York - Medieval Barber Credentialing – History

7. 13th century Paris - College de Saint Come to differentiate surgeons from barbers – both considered crafts requiring little education! –Academic surgeons (of the long robe) –Barber surgeons (of the short robe) To become a member of College a surgeon of the long robe –specific conditions for admission –pass an examination given by a panel of surgeons Credentialing – History

8. English Act of 1511 – reign of Henry VIII Concept of Local Control Preventing anyone from practicing medicine within 7 miles of London without being examined & approved by 4 expert physicians Outside of London, physicians were required to be approved by similar bodies in their own diocese Credentialing – History

9. 1751 – Benjamin Franklin & Dr. Thomas Bond – Pennsylvania Hospital, the 1 st hospital in America still uncommon for practicing colonial physicians to have attended a formal medical school – Franklin required physicians to be –at least 27 years old –apprenticed within the city of Philadelphia –studied physick & surgery for at least 7 years –pass an examination by 6 hospital physicians before admitted to the housestaff –If not a resident of Philadelphia, required to reside in the city for at least 3 years before being examined Credentialing – History

10. 1990 – National Practitioner Data Bank To track of professional misconduct across all 50 states Despite NPDB, infamous cases of physicians using altered documents & causing great harm Rise of CVOs (Credentialing Verification Organizations) National Committee for Quality Accreditation (NCQA) 2004 – The Joint Commission implemented standards for the credentialing and privileging of telehealth practitioners Allowed for “credentialing by proxy” Not recognized by CMS May 2011 – CMS releases TM Credentialing Rule Revised Conditions of Participation allowing for Delegated Credentialing Credentialing – History

11. What it Looks like… Impact on both originating & distant site

12. We’re not alone…

13. How to best balance Need of local hospitals to safely allow physicians onto their medical staff Need to improve Access to & Quality of Care via Telemedicine Decrease paperwork & time (= $‘s) associated with (at times) redundant credentialing process Senate Bill 569 –Standardized List to be developed by OHA workgroup

14. telemedicine Thank You