Credentialing & privileging column: Write now or forever hold your peace

Communicating reference information about physicians has always been a challenge for medical staff leaders and medical staffs. How much should we say? Can we get into trouble with our answers? How can we maintain collegiality regardless of what information we provide? A new best practice to address these concerns is to create a forever more verification letter.

For years, department chairs and medical staff officers gave the best reference information they could to other organizations that were trying to fulfill their credentialing processes. Then the Kadlec case came along and forced medical staffs to reassess how they communicate with each other regarding physicians and their performance.

Now, I am not a lawyer, and I didn’t stay at a Holiday Inn Express last night, but I believe there are two major takeaway messages from the Kadlec case. First, if you are relaying information to another organization, tell the truth or don’t say anything at all. You’re asking for trouble if you make statements that are not supportable by the facts. If you choose to remain silent with a typical name-rank-and-dates reference letter, that lack of information should send up a red flag for the receiving organization. Second, if you are requesting information, ask specific questions to get at the details you require. Broad or non-specific requests allow for the other organization to hide details about a physician that may be negative.

Often times, these requests come long after the practitioner has left your facility. This is the situation I really want to address here. We find that many medical staff leaders are stymied when they try to recall a physician’s performance from a file that has started to collect dust. It was hard enough making the correct credentialing and privileging recommendation when the physician first applied, much less three to five years after they have left.

Therefore, as I mentioned, we recommend creating a forevermore reference letter when any practitioner from your staff leaves the organization. By writing a letter of reference as soon as the physician resigns, medical staff leaders can capture the most accurate picture of the physician’s performance while at your institution. The letter should summarize the practitioner’s organizational experience and include activity and quality information as well. This letter should also reflect the physician’s competence based on all dimensions of a competency framework, such as the six general competencies developed by the Accreditation Counsel for Graduate Medical Education and adopted by The Joint Commission.

Because the person is leaving your organization, no further data input will affect your recommendation anyway, and, by using the forevermore reference technique, you will maintain the most honest and accurate picture of that person. Once the letter is complete, place it into the credentials file and maintain it there forever. If any inquiries or letters of reference request arrive in the future, refer to this letter when drafting your reply.

Most typically, the department chair is tasked with writing the forevermore reference. If other medical staff leaders usually get involved with primary recommendations for credentials and privileges at your facility, they can write the letter instead. I recommend writing this letter within 30 days of the practitioner’s departure.

Although The Greeley Company has historically said that retiring physicians don’t need forevermore references, we are starting to rethink that stand in light of the present economy. With retirement plans going south faster than the birds can migrate, many retired physicians want to resume practice. Many are taking on part-time clinical work as locum tenens or in a clinic. Unless the practitioner is clearly never going to practice medicine again, the forevermore letter is great to have on hand.

For both efficiency and accuracy, give some thought to writing the forevermore reference. For more tips on writing forevermore references and other post-Kadlec best practices, check out this article from Medical Staff Briefing. 

If this or any other credentialing and privileging issues arise, please feel free to contact us in the Credentialing and Privileging Practice of The Greeley Company at any time.

Wishing you all a safe and happy summer.

Mark A. Smith, MD, MBA, CMSL is the director of credentialing and privileging services at The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.