Illinois Blockchain Initiative to Pilot Credentials Verification Program

On August 8^th, 2017, the Illinois Blockchain Initiative announced a pilot program in partnership with Hashed Health to use blockchain technology to streamline the medical credentialing process in the state. By exploring opportunities through distributed ledger technologies, the program could be able to reduce the complexity of licensing and credentialing. The program will look to provide a new blockchain-based registry to act as a repository for credentialing data.

Eric Fish, senior vice president of legal services at the Federation of State Medical Boards, praised the initiative, remarking that, “If successful, this effort may prompt other state medical boards, as well as others within healthcare, to investigate potential benefits that can be derived from the use of distributed ledgers, and may ultimately result in a more efficient regulatory process without any sacrifice to patient safety.”

To read more on the pilot program, see the full story at Health IT Analytics.

Blockchain technology is a decentralized peer-to-peer system through which digital transactions are created, shared, verified, and stored. This technology consists of three main components: a distributed network, a shared ledger, and digital transactions. The network is the basic skeleton of the blockchain: individual network members generate, verify, and store data on the blockchain, instead of contributing to one central database. The ledger provides a mechanism to share and verify information in the network, protecting the data from tampering and ensuring quick and easy verification of the information within. Finally, a digital transaction is the actual act of generating or verifying data.

NAMSS is continuing to monitor the development of blockchain technology in healthcare, especially with regards to the credentialing process. In May, we hosted our 4^th annual Government Relations Industry Roundtable, entitled Building Blocks for the Future. A panel of NAMSS staff, stakeholders and strategic partners discussed the impact of blockchain and its potential applications for the industry. Be on the lookout for further information from NAMSS on blockchain technology and its potential impacts on MSPs!

Utah Approves Bill on Negligent Credentialing

Both the Utah House and Senate have approved a bill that bars negligent credentialing as a cause of action in medical malpractice suits.

SB 150 reverses a May 2010 Utah Supreme Court decision which allows plaintiffs to include hospitals in malpractice suits on the grounds that the hospital should not have given credentials to a practitioner with a past history of questionable actions. The majority of states still recognize negligent credentialing as a cause of action in malpractice suits.

History of the bill can be found here:
http://le.utah.gov/~2011/htmdoc/sbillhtm/sb0150.htm

An overview of arguments for and against the bill can be found here (Salt Lake City News):
http://www.cityweekly.net/utah/article-13298-sb150-could-let-hospitals-off-the-hook-for-hiring-bad-docs.html

Proposed Legislation Would Require Transparent Disclosure of Credentials

Rep. John Sullivan (R-OK) and Rep. David Scott (D-GA) have re-introduced a bill which would require healthcare professionals who advertise services to state that they possess the license that authorizes them to perform the services listed. The bill, which is titled the Healthcare Truth and Transparency Act, is supported by groups such as the American Medical Association and American Osteopathic Association.

Introduction of the bill follows a trend among states that have passed legislation to ensure that patients are more aware of the credentials held by health professionals.

To read more, click here:
http://www.ama-assn.org/amednews/2011/02/07/prl20207.htm


Source: amednews.com

Useful Articles from the AMA

Below are two useful articles from the American Medical Association (AMA):

• Credentialing files maintained by hospitals should be protected against disclosure even if subpoenaed, according to a recent ruling by the state of Michigan Court of Appeals. http://www.ama-assn.org/amednews/2011/01/24/prsc0125.htm
  
  
• CME courses starting to focus on disciplined doctors and how they can prevent future mistakes. http://www.ama-assn.org/amednews/2011/01/24/prsa0124.htm

Source: amednews.com

Hospital Researcher Found to Have Neither a Medical Degree Nor a PhD

A recent story in The Detroit News discusses the case of William Hamman, a researcher at Western Michigan University who claimed that he had a medical degree as well as a PhD. Hamman had allegedly been working on journal articles on patient safety and care before his credentials were found to be false.

Hamman had impressive credentials in the aviation industry and had worked with WMU on a project to study how aviation industry standards could be applied to improve safety in healthcare. In 2009, Hamman joined William Beaumont Hospital to help train the members of the medical staff on communication and teamwork skills. Hamman was never a member of the medical staff, nor did he provide patient care.

To read the full story, click here:
http://www.detnews.com/article/20101215/METRO02/12150355/1409/WMU--hospital-researcher-lied-for-years-about-Ph.D


Source: detnews.com

Arkansas Court Strikes Down Economic Credentialing

The Arkansas Supreme Court upheld a 2009 decision stating that a hospital could not deny staff privileges to physicians with an ownership stake in competing hospital based on financial concerns because this policy violates state laws.

Baptist Health in Little Rock, Arkansas denied staff privileges to 12 physicians stating that its conflict of interest policy permitted the hospital to do so because of the economic interests of the facility.

Organizations such as the American Medical Association joined the physicians as plaintiffs, stating that restricting physician practice through economic credentialing restricts patient choice and that physicians should be evaluated on performance, not financial factors.

This is the highest court decision issued on the subject of economic credentialing. The AMA states that it is an issue that if challenged again, will be determined on a state-by-state basis.


Source: amednews.com
http://www.ama-assn.org/amednews/2010/10/18/prsc1018.htm

Utah Supreme Court Recognizes Negligent Credentialing as a Valid Claim

On May 14, the Utah Supreme Court recognized negligent credentialing as a valid cause of action in a legal claim against a hospital in Archuleta v. St. Mark's Hospital.

The plaintiff, Tina Archuleta, had undergone a laparotomy procedure performed by Dr. R. Chad Halversen at St. Mark's Hospital. Two days later, she was admitted to another facility, experiencing pain and complications from the procedure. Archuleta underwent six surgeries to correct the procedure.

Archuleta filed a suit against Halversen and St. Mark's Hospital. In her complaint against the hospital, she claimed that St. Mark's "failed to seek consult when appropriate, inadequately trained healthcare provider employees, negligently credentialed. . . [Dr.] Halversen and generally fell below the standard of care."

The district court dismissed her negligent credentialing claim, stating that such action was barred by the sections of the Utah Code that protect the dissemination of peer review information. The Utah Supreme Court ruled that the district court was incorrect in its application of the code, ruling that "the immunity contemplated under the statue operates between a doctor whose credentials are under review and the suppliers of information and decision makers; it does not contemplate immunity between a patient and a hospital."

In its opinion, the Utah Supreme Court stated that there is a public interest in recognizing negligent credentialing claims because there is a "foreseeability of harm to patients where hospitals fail to properly investigate a doctor's qualifications" (citing Johnson v. Misericordia), and because of the "superior position [of hospitals] to monitor and control physician performance" (citing Domingo v. Doe).

To read the full opinion, click here:
http://www.utcourts.gov/opinions/supopin/Archuleta2051410.pdf

Submit Your Thoughts for an Upcoming Synergy Article

This year, NAMSS and CAQH are collaborating on the shared goal of identifying ways to increase efficiencies in the credentialing process. An upcoming issue of Synergy will feature an article on CAQH’s Universal Provider Datasource (UPD) and application. For this article, we are looking for feedback from the membership with your thoughts as a user of the UPD and CAQH application. The article will highlight the feedback of the membership and will provide an update on how CAQH is working to make the UPD system easier to use.

The NAMSS Industry & Government Relations Committee has already provided comments to CAQH with ideas on how to improve their application for the hospital-user community. NAMSS is pleased that CAQH is reviewing the committee’s proposed changes for inclusion in a future version of their application. CAQH wants to hear more about your experiences so we can work together and can continue to make the application and UPD system more user-friendly for providers and credentialing professionals.

Here is your chance to share your experiences on using the system with both the NAMSS membership and CAQH. To provide your experiences for the article, complete the following survey by Friday, May 21:

http://www.surveymonkey.com/s/WTCZ8C5

Questions can be sent to news@namss.org.

Angie's List Encourages Patients to Make Sure Their Healthcare Providers Are Licensed

Angie's List, a consumer-focused website that allows people to post review services and contractors, recently released an article encouraging patients to check to make sure their healthcare providers are practicing under a current license.

91 percent of respondents said that it is "crucial that their health care providers are licensed," yet most respondents do not check for licensure themselves.

The article presents several interesting situations of unlicensed medical professionals and the potential dangers of having these providers see patients. The article does recognize that many of the "unlicensed" professionals are simply professionals who have let their license expire. Matt Haddad, CEO of Medversant, noted the importance of seeing a properly credentialed provider.

This article is good at highlighting the value of the MSP from the consumer perspective. Patients should not have to ask their providers for proof of licensure when they enter a hospital or call an office to schedule an appointment. They should be able to seek care, knowing that their provider is licensed and competent. It is our job as MSPs to keep sanctioned providers away from patients, and to ensure that providers know the importance of licensure and do not let it lapse.

To read the full article, click here: http://magazine.angieslist.com/Articles/2010/May/NATIONAL/Check-medical-license-before-getting-checked-out.aspx


Source: Angie's List

Missouri Legislation Proposes 45-Day Credentialing Window

Missouri House Bill 2450 (HB 2450), the "Prompt Credentialing Act," would require every health carrier in the state to complete verification of a physician's credentials and to make a credentialing decision within 45 days after receiving a complete application. If a decision is not made within the timeframe, then the health carrier must grant provisional credentialing status until a final determination is made. The bill also requires health carriers to retroactively compensate physicians for services rendered since the date of his or her application.

Making credentialing decisions more efficient is certainly a positive step. However, did lawmakers adequately consider the factors that play into the credentialing process when setting this timeframe? For example, hospitals with a delegated agreement would have a hard time meeting a 45 day timeframe. Also, the 45 day window doesn't encourage physicians to complete the application any faster, since it is imposed on the credentialing verification process.

Finally, what if additional investigation needs to be done on a physician's record and the 45 day timeframe lapses? Are hospitals comfortable with having a member on the medical staff with provisional status if they are still investigating a possible "gap" in his or her file?

NAMSS will work with members in Missouri to ensure that any concerns are communicated to lawmakers before this piece of legislation is voted upon. The bill currently has a proposed effective date of August 2010.

What are your thoughts on this issue? Do you have a credentialing timeframe in your state? If so, how long is it, and have you run into any problems because of it? Share your thoughts in the comment field below this post on the NAMSS Blog website.

To read Missouri HB 2450, click here:
http://www.house.mo.gov/billtracking/bills101/billpdf/intro/HB2450I.PDF.

ABP Provides Clarification on Provider Status Reporting

The American Board of Pediatrics (ABP) has provided clarification on how to credential diplomates now that they have implemented their Maintenance of Certification (MOC) program and will no longer issue certificates with specific end dates.

The ABP recommends entering January 1, 2010 as the re-verification date for all diplomates enrolled during 2009.

A memorandum with the guidance, along with a letter that was sent to diplomates can be found here:
http://www.namss.org/Portals/0/ABP%20Change%20in%20Certification%20Status%20Reporting.pdf

New York Medicaid Adopts CAQH UPD

CAQH has announced that the New York State Department of Health, Office of Health Insurance Programs has adopted the Universal Provider Datasource (UPD) for the electronic collection of provider data for the state's Medicaid program.

The UPD is an online service that stores provider data for credentialing, claims processing, and other purposes. The system is designed to reduce the administrative burden for providers and healthcare entities.

"We are pleased that New York Medicaid has selected the Universal Provider Datasource to supplement its program administration," said Robin Thomashauer, executive director of CAQH. "The UPD is valued by providers, health plans and hospitals nationwide as a tool for reducing the time and expense associated with network enrollment."

For the full press release, click here:
http://www.caqh.org/PR201003.php.


Source: CAQH

NCQA Response Regarding American Board of Pediatrics Certification Changes

NCQA was recently contacted regarding the American Board of Pediatrics' (ABP) implementation of the Maintenance of Certification (MOC) program and elimination of certification expiration dates. NCQA was asked how the change will affect scoring of pediatricians in 2010 and beyond for CR 3 Element A factor B.

NCQA provided the following response:

"We are investigating the changes in the ABMS policy to determine whether or not a change to our board certification verification requirements is appropriate. Once we have reviewed the ABMS policy, we will notify customers of any changes through the Programs section of our Web site (http://www.ncqa.org/tabid/58/Default.aspx). Any changes will be posted as a Policy Update; to access any changes, please visit the Web site provided and click on "Policy Updates and Supporting Documents" and then on "Corrections, Clarifications and Policy Changes." The next Policy Update is scheduled for March 29, 2010."

NAMSS will continue to alert the membership as more information regarding the ABP's changes becomes available.

New CMS Regulation for Foreign-Born Physicians

The Centers for Medicare and Medicaid Services (CMS) has issued a new regulation regarding the verification of legal status of foreign-born healthcare professionals. CMS provides the following summary of the rule:

"If a newly-enrolling physician or non-physician practitioner indicates in Section 2 of his/her Medicare enrollment application (CMS-855I or Internet-based PECOS) that he/she was born in a foreign country, the contractor shall verify that the physician or non-physician practitioner is: (1) a United States citizen; (2) a legal resident of the United States, or (3) otherwise legally authorized to work in the United States. The purpose of this change request is to help ensure that all enrolling physicians and non-physician practitioners are legally authorized to perform Medicare services. "

The regulation will be implemented and ruled effective on March 29, 2010.

The full transmittal describing the new regulation can be found here:
http://www2.cms.hhs.gov/transmittals/downloads/R323PI.pdf.


Source: CMS

Report Calls for Improved Oversight over Credentialing and Privileging in VA Medical Centers

The Government Accountability Office (GAO) conducted a review of six Veterans Affairs medical centers (VAMCs) to determine if VA policies on credentialing and privileging were being properly implemented. A report detailing this review was released this month.

The report shows that staff at the VAMCs studied were inconsistent in meeting credentialing standards. Some of the issues highlighted in the report include: improper verification of state licensure, failure to document physician performance information, and the failure to detect malpractice information that was not disclosed by physicians.

The VA has accepted the findings of the GAO report and has already taken steps to implement improved policies and oversight over the credentialing and privileging processes. Some of these improvements include: updating the VetPro system by September 2012, working with state medical boards to see if they will provide additional information for credentialing and privileging purposes, and amending the current VA policy so that written verification is not required for states that provide information that can be verified online or over the phone.

To read the full report, click here:
http://www.gao.gov/new.items/d1026.pdf.

NAMSS Letter to ABMS Regarding MOC Implementation

NAMSS has provided feedback to the American Board of Medical Specialties (ABMS) regarding the American Board of Pediatrics' recent implementation of the Maintenance of Certification (MOC) program.

While NAMSS supports the ongoing skill development required of physicians through the MOC, there has been little guidance on how this will change the credentialing process. For example, the American Board of Pediatrics has implemented a permanent certification, eliminating end dates, which are currently verified.

ABMS requested NAMSS' thoughts on the American Board of Pediatrics' changes to their certification policy. A letter was sent to the ABMS Executive Committee last week for consideration. NAMSS will keep the membership updated on this issue.

To read NAMSS' letter to ABMS, click here:
http://www.namss.org/Portals/0/ABMS_Letter_1_20_10.pdf.

Question of the Week: Using the Internet in Credentialing

Attorney Mark Kadzieleski recently gave a presentation in which he recommended that MSPs "Google" applicants and practitioners in the reappointment process.

While Google might not provide the same in-depth information as a primary source, it and other Internet search engines are definitely a resource worth considering. For example, HR professionals are increasingly using Google and conducting searches of applicants' social networking pages like Facebook and MySpace to gain more information about candidates. An Internet search of a practitioner's name may help MSPs discover not only information about a candidate's character, but also information such as additional practice locations that the practitioner may not have disclosed on his or her application.

It is important to remember that while it may be useful, an Internet search is not a verified source of information on an applicant. When performing an Internet search, make sure that the "John Doe" that comes up in your search results is the same "John Doe" that has applied for privileges at your facility.

The question of the week is, do you use Internet search engines to obtain information about applicants and those going through the reappointment process? If you are performing Internet searches of your applicants, let us know what type of information you have been obtaining in the comment field.

Improper Background Checks by Staffing Firms Are Connected to Hiring of Unfit Temporary Nurses

A report from ProPublica and The Los Angeles Times shows that hospitals may be using temporary RNs who are unqualified because of poor screening by staffing firms.

The report shows that many nurses with criminal histories, histories of poor performance, and improper credentials were able to acquire employment with a hospital because the staffing agency failed to perform a thorough background check or listen to warnings from other facilities. Some nurses were able to avoid being caught with unfit qualifications by moving to a new hospital before an investigation into their performance background could be performed.

Some attribute the rise in unqualified nurses to the nursing shortage. With hospitals needing to quickly hire nurses to meet their staffing needs, some facilities are relying solely on the background check performed by the staffing agency, without performing their own check.

While there are many quality temporary staffing agencies out there, this should also serve as a call to hospitals to do their due diligence when working with one. Your facility should always try to verify the credentials of temporary nursing staff. If this is not possible, then make sure that the staffing agency you work with has a proper credentialing system in place.

There may be a staffing shortage, but it is better to take the time to hire quality staff, than to meet staffing numbers with unqualified individuals.

To read the full article, click here:
http://www.latimes.com/news/local/la-me-nurses6-2009dec06,0,1174984.story.


Source: The Los Angeles Times

TJC Releases Telemedicine Revisions to Hospital Standards

The Joint Commission (TJC) has released revisions to the Leadership and Medical Staff chapters of the Hospital Standards in order to comply with CMS requirements for deeming authority.

Currently, TJC accepts credentialing and privileging by proxy. CMS currently requires that telemedicine providers be credentialed by both the originating and distant sites. TJC would have allowed the originating site (where the patient is located) to accept the credentials and privileges granted by the distant site (where the provider is located) if the distant site is TJC accredited and complies with the appropriate Medical Staff standards.

TJC has revised its telemedicine standards to comply with the CMS rule, but continues to work with CMS and Congress to accept credentialing by proxy by the distant site.

The revised standard is effective July 15, 2010 and can be found here:
http://www.jointcommission.org/NR/rdonlyres/73A1C766-37B6-4EB2-BEB3-2A59C2BE841E/0/CMS_ChangestoCMSHospitalStandards_EPs_July15_20090929.pdf.


Source: The Joint Commission

Doctor Sues Georgetown University for Defamation and Breach of Contract

Dr. Carlos F. Gomez, medical director of the D.C. Pediatric Palliative Care Collaboration is suing Georgetown University for $1.25 million after he was denied staff privileges.

Gomez claims that Georgetown sought him to become a member of the medical staff despite the known fact that he had a past history of substance abuse. Gomez's complaint states that Georgetown rejected his credentialing application in August 2008 "imput[ing] that Dr. Gomez's history of substance abuse had caused harm to his patients." Gomez denies the claim and said that he had been sober for five years and had no malpractice or disciplinary actions against him when he applied to Georgetown.

The two parties settled in January, with Georgetown agreeing to keep his file confidential and to report that privileges were denied based on questions of Dr. Gomez's clinical competency due to his time away from practice.

Gomez claims that Georgetown violated this agreement by reporting to the NPDB that his privileges were denied due to a "diversion of controlled substances."

From an MSP perspective, it will be interesting to see how this case is ruled. We deal with denied applications all the time, but it is surprising to see the alleged settlement reached between the parties and the subsequent NPDB report that stems from this case.


Source: Washington Business Journal
http://washington.bizjournals.com/washington/stories/2009/08/31/story5.html