FPPE five years on: What have we learned? What works?

July 26, 2012
Credentialing Resource Center Digest - Volume 13 Issue 29

Dear Colleague,

When The Joint Commission (TJC) introduced the term focused professional practice evaluation (FPPE) five years ago, medical staff leaders and MSPs entered a period of uncertainty and confusion. Now, five years later, much has been learned and the confusion has faded. But implementing an effective FPPE program still remains a challenge for most medical staffs. Let’s look at what we’ve learned and what works.

What we’ve learned:

  • TJC applied the term FPPE to two distinct activities. The first involves drilling down in a “focused” way into the performance of an individual provider whose quality or behavior has become suspect. The second FPPE activity involves assessing provider competence for privileges recently granted to confirm the decision to grant these privileges was warranted. By now, most medical staffs have figured out the difference between these two activities.
  • Too many medical staffs implemented FPPE by conducting new, burdensome activities. These often involved real time observation (proctoring), a labor intensive and expensive activity for physicians to conduct. Today we know how burdensome real time proctoring is and that other, less burdensome FPPE options exist.
  • FPPE creates conflicts of interest, especially when a physician on staff is asked (or required) to conduct FPPE for a competitor. Sometimes this may be a new physician coming to town, and sometimes it’s a physician in a different specialty whose new privileges are part of a privileging turf battle.
  • It’s hard to demonstrate that FPPE activities add much value beyond meeting the TJC standard.

What works:

  • Start with a policy. Your FPPE policy should address the following elements:
    • Purpose
    • Medical staff oversight
    • Ethical positions of the medical staff
    • Scope of proctoring program
    • Responsibilities
    • Methods
    • Procedure
    • Reporting: Results and recommendations
  • Under the ethical positions, include:
    • Conflicts of interest
    • Disclosure to patients
    • Consent issues
    • Intervention by the proctor
    • Indemnification for proctors
  • Simplify your approach to FPPE by using the same metrics you’re already gathering (e.g. case reviews, core measures, complications) but measure them more frequently or look at the results more often
  • Minimize the use of real time proctoring, as this is the most labor intensive way to measure provider performance

FPPE continues to pose challenges, but applying lessons learned about what works will help you reduce the burden of FPPE and gain more value from your FPPE activities.

All the best,

Rick Sheff, MD
Principal and Chief Medical Officer
The Greeley Company