Credentialing policies to fall under scrutiny
60 Minutes gets attention of accreditation groups
It was one of those stories on Sunday night’s 60 Minutes that makes you dread going to work Monday morning.
In March, the television show profiled a hospital in Houston where, the show claimed, surgical assistants were presenting themselves as MDs.
Same-day surgery experts predict fallout from this story. In fact, some patients already are insisting that no one except another MD assist their surgeon.
"That’s the patient’s choice," says Jeff Reichardt, RN, BSN, CNOR, a registered nurse first assistant and a certified surgical assistant in Cincinnati. "You have to support it, although it’s dammed inconvenient."
In addition to that inconvenience, expect accreditation groups to take a harder look at your credentialing policies and procedures, predicts Jon Stenseth, MD, a practicing surgeon in San Jose, CA, and a surveyor for the Skokie, IL-based Accreditation Association for Ambulatory Health Care.
To avoid problems, follow these suggestions:
• Don’t let paperwork fall through the cracks.
Collect the original primary source licenses, background materials on experience, and continuing education materials to show that your practitioners are keeping up with the field and/or recertification licensure if required, Stenseth says.
Reichardt adds, "See to it that they have been through the appropriate certification process and have been through the appropriate classes."
• Check credentials and background to uncover any problems.
"That’s what killed me," says Reichardt, referring to the 60 Minutes story. "I was yelling at the TV: Where is the hospital credentialing committee?!’ They are ultimately responsible for who goes into the OR and operates."
In the story, the hospital and a national association for allied health professionals apparently neglected to verify physician reference letters attesting to the technical expertise of the surgical assistants in question, Reichardt says. According to 60 Minutes, those letters were forged.
"Credentials need to be checked by the facility first and foremost, or they get what they deserve," he comments. "Anybody could potentially come in and do everything."
Check with state licensing boards to determine whether the applicants have had any problems with their performance and examine how those problems were handled, Stenseth suggests.
• Establish a formal credentialing process for unlicensed health care practitioners.
Surgical assistants and other allied health professionals often are forgotten in the credentialing process, warns Melinda E. Whitney, RN, MS, CPHQ, CHE, coordinator and senior consultant at Quality Management Consulting Group in Columbus, OH.
"These tend to be somewhat forgotten, or we think human resources will take care of it," Whitney says.
While part of the issue concerns the workload of the staff persons handling credentialing, the real issue is how much the facility is willing to risk, she maintains.
"It’s difficult to put your hand up as credentialing professional and say, I’ll look into these non-physician, non-nursing practitioners or these positions that don’t fit what we’re used to,’" she says. "No one wants to look at more paperwork, but it’s conducive to look at this issue before you have a problem like the one on 60 Minutes."
The television story indicated that a large number of providers don’t have a formal credentialing process for unlicensed health care practitioners, says Martha Baxter, RDH, MS, JD, senior consultant and principal at Quality Management Consulting Group and partner at Bricker and Eckler in Columbus.
"Surgical technicians and surgical assistants should be credentialed just as any other staff person in a hospital, whether they’re employed or not," Baxter advises.
For persons who are not licensed in their state and not certified by a professional organization, a same-day surgery program could establish criteria to "grandfather in" individuals with experience.
"But they have to have definitive criteria ahead of time as to what would qualify as an equivalent," Baxter emphasizes. "With documented experience, they could be grandfathered in for 12 to 24 months until they can get certification."
Be careful about creating such a system, however, she warns. "This could create some problems if there are ever malpractice cases or credentialing claims with on-site or on-the-job training," Baxter says. "Unless the individual facility has a very stringent high-level training program in place, they’re really risking it with a fly-by-night, on-the-job training program, i.e., just letting surgeons bring in surgical technicians, train them, and there’s no consistent training criteria."
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