ABPS Acknowledges Contributions of MSPs to Healthcare Leadership in U.S.

The American Board of Physician Specialties joins the U.S. healthcare community in acknowledging the importance of medical service professionals (MSP) in commemorating the National Medical Staff Services Awareness Week. In 1992, President George Bush recognized the first week in November as National Medical Staff Services Awareness Week and since then, medical facilities and government agencies have celebrated the importance of medical services professionals.  ABPS promotes the importance of MSPs in verifying physicians’ credentials to help ensure the highest quality of medical care is delivered.

MSPs continue to evolve as they now have more roles to fill than ever before. MSPs performed more administrative duties in the past, but their role has developed to have more responsibilities such as working with gap analysis, primary source verification, telehealth credentialing, allied-health practitioner credentialing, and reconciling a manual process with new technologies. The medical industry has switched to electronic record keeping, which has reduced the number of workers in an organizations managed services office. Due to the lack of workers, MSPs are overloaded with a number of duties such as coordinating medical staff onboarding, managing credentialing, and acting as the liaison between hospitals and staff.

There is more demand for higher education and training among MSPs because of how complex the job has become. It is important to recognize the hard work MSPs perform on a daily basis as their role continues to become more challenging. View the article here.

Roxanne Chamberlain Attended the AHLA Annual Meeting

In June, Roxanne Chamberlain, MBA, FACHE, FMSP, CPMSM, CPCS, Senior Director of Medical Staff Services at Baystate Health, Inc. and 2019 NAMSS President-Elect, attended the American Healthcare Lawyers Association (AHLA) Annual Meeting in Boston, MA. Health law professionals attend the meeting each year for the most current information and analysis on a variety of legal issues affecting the healthcare industry. The annual meeting included thoughtful, practical, solution-oriented sessions, luncheons, and networking events.

John P. Ryan, President and Managing Partner, Hall Render Killian Health & Lyman PC and Heather Brace, Senior VP and Chief People Officer, Intermountain Healthcare, delivered the Meeting’s keynote address, The Future of the Health Care Workforce. The keynote session focused on the leading influences affecting the healthcare industry and their potential legal challenges. Experienced health law professionals facilitated breakout sessions on practice-management topics, top-physician compensation risk areas, understanding and addressing conflicts of interest at non-profit organizations, and coping with the mystery and reality of artificial intelligence (AI) in healthcare.

Roxanne attended many of the Meeting’s AI learning sessions, which included AI liability, and how it could affect the standard of care in medical malpractice cases, as well as how AI bedside assistance will simplify doctor and nurse workloads. Roxanne also attended sessions about healthcare policy and hazard prevention where she learned that efforts to reduce healthcare costs have made little progress, as states continue to file lawsuits regarding the Affordable Care Act. Additional sessions surrounded topics on practitioner conscious clauses and hospital-acquired infection reduction rates in 2018-2019.

Drug price transparency was another popular topic, as well as how states and the federal government are combating rising drug prices. Nine states have passed drug-price transparency laws and seven other states are in the process of passing legislation.

Roxanne also attended sessions related to healthcare data and telehealth and noted that the U.S. Chamber of Commerce continues to call for a federal data privacy law due to inconsistent state laws and the number of data breeches. The healthcare sector continues to embrace digital invocations as consumer demand increases. Healthcare law professionals recommended that hospitals take an interdisciplinary team approach to implementing telehealth proposals and their legal staffs should have multi-faceted telehealth competencies to handle with regulatory issues.

As NAMSS liaison to AHLA, Roxanne stands by as a resource to the membership and is available to answer additional questions or provide additional information about AHLA.

A Conversation with Dr. Peter Hill, 2019 CVO Excellence Symposium Keynote Speaker

The CVO Excellence Symposium, the first event designed for MSPs who work in credentials verification organizations (CVO), is a two-day event focusing on the crucial discussions related to the state of the CVO, exploring topics such as staffing models, legal and regulatory issues, technology and innovation, and streamlining processes from the top-down. NAMSS recently sat down with Dr. Peter Hill, the Symposium’s keynote speaker, who serves as the Senior Vice President of Medical Affairs for the Johns Hopkins Health System and Vice President of Medical Affairs/Chief Medical Officer for the Johns Hopkins Hospital, to discuss what he’ll cover in his keynote presentation:

1. Can you give a small preview of what you’ll be covering in your keynote presentation at the NAMSS CVO Symposium?

·        How health systems are embracing the ongoing challenges in healthcare.

·        Impact of telehealth services and the impact on credentialing these practitioners within a health system

·        Credentialing the “Virtual doctor/practitioner” and its impact within patient safety and quality

2. What are some of the primary challenges you’re looking to address in your keynote?

·        Developing delineation of privileges, credentialing criteria, and meaningful FPPE/OPPE for the use of artificial intelligence and the virtual doctor.

·        Onboarding practitioners in a timely manner within the hospitals and provider enrollment.  It is extremely important in today’s market that practitioners are “billable” on their effective start date.

·        Revenue cycle management begins with credentialing.

3. Why is the NAMSS CVO Symposium important for MSPs to attend?

The CVO Symposium is important for MSPs to attend as it provides focused knowledge on best practices utilized within various health system CVOs.  We learn from each other.  It is an opportunity to ask questions, network, and collaborate with one another or strategize to move organizations forward and provide safe care to our patients. 

4. Are you seeing a greater need for programming specific to CVOs in the larger MSP community?

Yes, as more and more health systems develop central credentialing or central verification offices, it is important for MSPs to learn from one another on various aspects of moving the profession, their specific organization and healthcare forward.  We are all working together to navigate the ever-changing world of health care.  By sharing knowledge with one another, we can all learn to become more lean and efficient while safe guarding our patients.

5. What do you hope MSPs will take away from your keynote address?

First and foremost, that we are all in this together.   Healthcare is continuing to change and MSPs are at the forefront of patient safety.  With the emergence of digital healthcare and ongoing issues with “access,” I hope MSPs take away that they have a voice and opportunity to make a difference in their health system by working collaboratively with their leadership and feel empowered to share their innovative ideas.  There is never a dull day working in healthcare and by networking and collaborating with one another, we can make a difference.

The 2019 NAMSS CVO Excellence Symposium takes place October 19-20 at the Philadelphia Marriot Downtown in Philadelphia, PA. Register today.

New Member Resource: NAMSS-ATA Credentialing by Proxy Guidebook

NAMSS is pleased to introduce the NAMSS-ATA Credentialing by Proxy Guidebook, a resource for navigating the credentialing process for practitioners providing remote/telemedicine services. The Guidebook includes a standardized Glossary of Terms, an overview of the existing credentialing process with a focus on telemedicine providers, a review of existing laws and regulations around telemedicine credentialing, a set of guidelines for creating a credentialing by proxy program, and a review of hurdles and potential solutions institutions often encounter with credentialing by proxy.

The Guidebook is the result of a multi-year collaboration between NAMSS and American Telemedicine Association (ATA). In 2017, NAMSS staff and ATA staff convened a joint task force of NAMSS and ATA members to develop a credentialing by proxy guide. Credentialing by proxy is relatively new process by which hospitals using remote practitioners for telemedicine services can accept the remote hospital’s credentialing work, rather than requiring the full traditional credentialing process for practitioners who may never step foot into that facility.

NAMSS and ATA will continue to collaborate to provide resources that facilitate efficient and effective credentialing for institutions and practitioners providing or using telemedicine services. The NAMSS-ATA Credentialing by Proxy Guidebook reflects the current process and credentialing by proxy landscape. NAMSS and ATA will continue to work together to update the Guidebook as necessary and will review the Guidebook on a regular basis to ensure it reflects industry updates.

NAMSS would like to thank the following NAMSS members for their work on the NAMSS-ATA Credentialing by Proxy Guidebook Task Force: 

LouAnn Brindle, MSN, RN, CPCS, CPMSM

Susan Diaz, CPCS, CPMSM 
Beth Erwin, CPCS, CPMS 
Becky Findley, CPMSM, CPCS, FMSP 
Geneva Harris, CPCS, CPMSM 
Lisa "L.J." Jones, CPCS 
Judy Lentz, CPMSM, CPCS 
Diane Meldi, MBA, CPCS, CPMSM 
Kathy Risch 
Linda Waldorf, BS, CPMSM, CPCS

Please contact Molly Giammarco, NAMSS Senior Manager for Policy and Government Relations, with any questions on the Guidebook.

NAMSS Releases its Sixth-Annual Industry Roundtable Report

The 2019 NAMSS Roundtable Report is now available.  NAMSS held its sixth-annual Roundtable discussion with industry stakeholders from 20 organizations including NAMSS on May 9, 2019 in Washington, DC. The past five NAMSS Roundtables have helped institute significant reforms to the credentialing, privileging, and licensure processes. This year’s Roundtable, Credentialing for Tomorrow, facilitated a discussion around adopting a more modern credentialing process while prioritizing patient safety.

The 2019 Roundtable continued to delve into the technology innovations of 2018 with a focused discussion on digitizing credentialing. The report provides an overview of the high-level discussion about how credentialing will evolve as more entities adopt and embrace technology. The report addresses the perspectives of hospitals, practitioners, payers, accrediting bodies, and government oversight entities on the importance of digitizing credentialing and the challenges associated with full adaptation.

Susan Diaz, NAMSS President, moderated the Roundtable presentation and Susan DuBois, NAMSS Government and Industry Relations Liaison, led the Roundtable participants’ discussion. The Report outlines several themes Roundtable participants discussed, including inconsistent enrollment quality standards, the lengthy process of credentialing a practitioner, excessive verification processes, credentialing non-physician practitioners, and institutions unwillingness to invest in credentialing technologies.  

The Roundtable also featured a discussion by FSMB that provided an update on FSMB’s research into digital credentialing, which compared legal, compliance, and technical aspects of digital signatures, open badges, and block chain.

NAMSS led a presentation with participants discussing their main credentialing pain points and potential alternatives or solutions to these pain points. NAMSS will continue to work with Roundtable participants and other stakeholders to develop standards, embrace innovation, and identify credentialing gaps and shortfalls as technology continues to advance.

The following organizations participated in 2019 Roundtable:

•          Accreditation Council for Graduate Medical Education (ACGME)
•          American Association of Nurse Practitioners (AANP)
•          American Academy of PAs (AAPA)
•          American Board of Medical Specialties (ABMS)
•          American Hospital Association (AHA)
•          American Medical Association (AMA)
•          Blue Cross Blue Shield Association (BCBS)
•          Centers for Medicare and Medicaid Services (CMS)
•          Council for Affordable Quality Care (CAQH)
•          DNV GL Healthcare
•          Educational Commission for Foreign Medical Graduates (ECFMG)
•          Federation of State Medical Boards (FSMB)
•          Health Resources & Services Administration (HRSA)
•          Healthcare Facilities Accreditation Program (HFAP)
•          The Joint Commission
•          Medical Group Management Association (MGMA)
•          Nation Council for Quality Assurance (NCQA)
•          National Practitioner Data Bank (NPBD)
•          URAC

ABMS Names Diane Meldi as Stakeholder Council Liaison to the Information and Data Sharing Task Force

NAMSS congratulates Diane Meldi, MBA, CPCS, CPMSM on being named as Stakeholder Counsel Liaison to American Board of Medical Specialties’ Information and Data Sharing Task Force. The Information and Data Sharing Task Force is one of five Task Forces ABMS created to execute its Achieving the Vision plan to develop a continuing certification program that achieves high quality patient-care standards.

The Task Force will develop research and data-sharing strategies to guide future certification assessments, enhance diplomat education, and communicate requirements and standards to strengthen and advance specialty learning and improvement goals. Through collaborations between ABMS Member Boards and key stakeholders, ABMS seeks to learn how continuing certification affects change in diplomat practice, professional development, and patient-care delivery.

As Liaison, Diane hopes to serve NAMSS members by influencing and reporting on ABMS data update frequency and their timeliness of changes. Diane recognizes the challenges and opportunities MSPs have regarding data sharing, “MSPs need to ensure that all data sources are accepted by federal and state regulations and accreditation standards. Additionally, managed care plans need to accurately reflect a physician’s certification status for their marketing materials. Opportunities associated with data sharing are faster verification, lower costs, and the ability to share the importance of physician board certification.”

MSPs can benefit from, and influence, clinical data-sharing processes and policies by demonstrating the role timely and accurate data has in ensuring credentialing excellence and efficiency. Diane’s liaison role will also help show how data sharing can improve the payer and practitioner credentialing processes. “Health care organizations may require certification and recertification and depend on accuracy and timeliness. The number of days to complete the initial credentialing process is getting shorter and shorter. This would ensure that MSPs can get the verifications requested faster.”

The ABMS Stakeholder Liaisons will provide guidance to the Oversight Committee and providing recommendations to the five Task Forces:

• Advancing Practice

• Information and Data Sharing

• Professionalism

• Remediation

•        Standards

The ABMS Commission Task Force Oversight Committee determines each Task Force’s deliverables and timelines. Stay tuned for more updates from Diane Meldi on the progress of the Information and Data Sharing Task Force.

Click here to read the Continuing Board Certification: Vision for the Future Commission's Final Report. Click here to read more about the ABMS Vision Initiative. Click here to read more about the five Task Forces.

NAMSS Updates Ideal Credentialing Standards for Practitioner Applicants

NAMSS has recently released an updated version of the Ideal Credentialing Standards, which outline best practices for the initial credentialing of independent practitioner applicants in medical facilities. The Ideal Credentialing Standards were initially released in 2014, having been developed with a coalition of notable industry representatives across the credentialing ecosystem. In 2019, members of the NAMSS Board convened to review and update the Standards to align with current best practices in the credentialing profession.

The Ideal Credentialing Standards have been recognized as an essential document for determining the gold standard of practitioner credentialing for the past five years. In order to ensure that the Standards remain reflective of the highest level of credentialing practice, NAMSS Board members reviewed the Standards and analyzed new developments in credentialing nationwide. The working group included updates to the standards around identity proofing, education and training, and military service, and revised the list of potential red flags. Additionally, the group detailed recommendations around Internet background checks and social media review, as applicants’ online history continues to be a thorny issue for Medical Staff Offices.

The updated edition of the Ideal Credentialing Standards can be found on the NAMSS website.

GAO Report Reveals VHA’s Need for Improvement in Credentialing and Hiring Process

            A report from the U.S. Government Accountability Office discovered that the Veterans Health Administration had overlooked or missed adverse actions that were reported to the National Practitioner Data Bank (NPDB) while hiring physicians and other healthcare providers. The GAO analyzed healthcare providers at the VHA as of September 2016 who were recorded in NPDB, and found that VHA facilities did not consistently act within VHA employment policies and hired providers with various disqualifying adverse actions.

Staff that were involved in the credentialing and hiring process in at least 5 facilities did not have knowledge of the VHA policy regarding hiring providers with revoked or surrendered licenses due to misconduct or incompetence. VHA officials have stated that they are developing improved processes to verify credentials of providers and ensure they meet all requirements. In December 2017, the VHA conducted a review of all licensed providers and removed 11 that did not meet the licensure requirements, but these reviews are infrequent.

 The GAO made seven recommendations on how the VHA can better their reviewing and hiring process. The recommendations included that the VHA should implement mandatory training periodically for facility staff that is responsible for verifying credentialing and hiring.

Click here for more information regarding the GAO report on VHA.

ABMS Vision for the Future Commission Releases Report on MOC Process

On December 11, 2018, the ABMS Vision for the Future Commission released a report regarding their review of the MOC process. The Commission was tasked with reviewing MOC within the current medical profession and confronted issues that ABMS Boards and Diplomats experience. The Commission addressed areas that are problematic for physicians and provided recommendations for overhauling the MOC system, including retiring the “maintenance of certification” terminology. It remains to be seen what specific changes the ABMS will make to the MOC process, but the commission’s report represents a concerted turn towards real change in the current status quo.

                The Commission also recommended that ABMS boards conduct research to analyze the success of continued certification in helping clinicians provide quality and safe care for their patients. In addition, ABMS should research potential activities that help clinicians maintain their skills. The commission did not directly address fees, yet the survey measured that 58% of doctors said MOC costs were their top concern, 52% said MOC was a burden, and 48% said MOC was not a true reflection of their abilities as clinicians. The Commission report suggested shifting from single point-in-time assessments leveraged years apart to more regular, longitudinal, multi-source assessments to provide more useful appraisals of physicians’ ongoing competence. The report also encouraged medical staff offices and other credentialing professionals not to make credentialing and privileging decisions solely on the basis of certification status, but to utilize certification as an additional data point when evaluating practitioner applicants.

Commission Co-Chairs Christopher Colenda, MD and William Scanlon, PhD told Medscape that while fee structures and pricing were not addressed in the Commission report, they noted that boards should implement reasonable fees. They believe that the changes recommended will enhance the value of the MOC process for all stakeholders. Former NAMSS Presidents, Linda Waldorf and Diane Meldi contributed to the Commission’s work.

Click here to read the Commission’s draft report and here for more information regarding the ABMS commission report on MOC. NAMSS will continue to monitor any further actions of the Commission and changes to the MOC process.