How to credential pediatricians based on the ABP's new maintenance of certification policy
As we mentioned in the January 20 issue of Medical Staff Leader Connection, certification with the American Board of Pediatrics (ABP) is now contingent on pediatricians continuously meeting maintenance of certification (MOC) requirements, and all newly issued certificates no longer carry an end date. (For those who have not yet seen the memo to credentialers explaining this change, it may be found at https://www.abp.org/MOCVerification/Credentialers.pdf.)
ABP’s approach raises the bar for physicians who are required to demonstrate clinical competency. However, medical staffs and the credentialing experts who support them are left wondering how to handle the fact that physicians’ certificates will no longer contain an end date. This month, we will walk medical staffs and credentialing specialists through four best practices for implementing the new ABP policy.
Step 1: Start with the “Five Ps”
The “Five Ps” is The Greeley Company’s shorthand way of referring to an important principle of effective credentialing:
Our Policy is to follow our Policy. In the absence of a Policy, our Policy is to develop a Policy.
Start by reviewing your medical staff’s policy regarding board certification and ask yourself whether your medical staff currently requires a physician to be board certified to be eligible for either membership or privileges. Next, ask yourself whether your medical staff requires physicians to be current in the MOC process to be eligible for membership or privileges. If the answer to both of these questions is no, then the policy change by the ABP affects neither the membership nor privileges of physicians on your medical staff. If you answered yes to either of these questions, then you must clarify in your policy how physicians’ MOC status affects their eligibility for membership and privileges.
Step 2: Subtract all physicians for whom the ABP’s new policy does not apply
Recognize that the ABP’s policy only applies to pediatricians who achieved board certification after May 1, 1988, with the exception of subspecialty certification in critical care and pulmonology. Pediatricians initially certified prior to that date are permanent certificate holders and should be deemed board certified for the rest of their careers. Please note that your medical staff may still choose to require a physician to be current in the MOC process to be eligible for membership or privileges, regardless of whether they were board certified prior to May 1, 1988. In the experience of The Greeley Company, most medical staffs have not embraced raising the bar to the extent that they would make a physician who is not current in the MOC process ineligible for membership or privileges on their medical staff. However, with the increased focus on MOC, this may become a more accepted standard in the field. Keep in mind that although some of the other 23 ABMS-approved boards are considering a similar change to that adopted by the ABP, it may not be adopted across the board, and it does not apply at this time to any of the 18 American Osteopathic Association boards. Therefore, medical staff leaders and MSPs will need to stay abreast of future certification changes board-by-board.
Step 3: Determine if the absence of an end date for board certification creates a problem for your credentialing process
Even if your medical staff does not require board certification for membership or privileges, your policy may require that a completed application include verification of board certification, including the date that the certificate expires, as applicable. In fact, most credentialing software programs include a designated field for the certificate’s date of expiration. Due to the new ABP policy, any pediatrician who received initial board certification after 1988 will no longer have an end date of their certification, meaning your current policy, and perhaps even your credentialing software, may make such an application incomplete. Therefore, these applications need revised so that they are not deemed incomplete because of unobtainable information.
Step 4: Establish a new process for verifying pediatric board certification
If your current policy deems pediatricians’ applications without board certification end dates incomplete, draft a policy that creates an alternative for verifying board certification. For example, your policy may allow you to enter a generic date into the application file. In the case of ABP certification, you can use the generic date of January 1 because the ABP continuously verifies the status of each board diplomate and recommends that medical staffs verify whether each physician is current in the MOC process after January 1 of each year. What this means in practice is that a pediatrician who is current in the MOC process as of January 1 of the current year will be deemed board certified for a period of time that will expire January 1 of the following year. The only time this would not be the case is if the pediatrician undergoes significant professional sanction, such as having their license revoked, an event the hospital should be informed of through sources unrelated to board certification. This means that your credentialing process should confirm MOC status annually on or shortly after January 1 for each pediatrician on your medical staff who was initially board certified after May 1, 1988. Though this creates somewhat more work for credentialing specialist, it solves the challenge of potentially creating incomplete applications and causing software problems.
The ABP and ABMS are working closely to help meet the reporting needs of credentialers, while continuing to emphasize the integrity and importance of MOC. Your medical staff does not have to wait until these discussions are concluded to put in place a process that works for you. Keep it simple, and establish a way to credential pediatricians as you do other physicians on your medical staff.
Rick Sheff, MD, CMSL is the chairman and executive director of The Greeley Company, a division of HCPro, Inc.