Rules for references

Many processes related to credentialing and privileging are "traditional" in nature. For example, the best credentialers constantly question every facet of credentialing to ensure that processes are streamlined, but maintain integrity (i.e., make sure the right questions are being asked of the right people and appropriate information is verified from primary sources).

Another traditional credentialing process is to ask applicants for the names of peer references.

Peer references are important in the initial appointment process as a source of information about the applicant's current clinical competence. A peer is defined as a practitioner who possesses the same type of professional license and qualifications as the applicant. Additional qualifications for a peer recommendation include the following:

·        the peer should not be related to the applicant

·        the peer should not be financially related to the applicant

·        the peer should have recent contact/experience with the applicant (i.e., in the past three to five years)

I've worked with several medical staff organizations in recent months where the members of the credentials committee have expressed frustration with the quality of the information that peer references have provided. They were frustrated because they thought that they were limited to using only those names that the applicant had provided for references.

An applicant does not always provide references for all relevant practice areas and time periods. For example, if an applicant completed his or her residency training four years ago and has since practiced in two locations, it is important for the medical staff office to obtain a peer reference from the residency training director and from each of the two practice locations. However, the applicant may provide names from only the most recent practice location. When the applicant signs the waiver/release on an application form, he or she typically agrees that the credentialing organization has the right to check with any individual or facility that potentially has information about his or her competency. In the case of the applicant with two practice locations in the past four years, a reference from each practice location should be sought.

There are many ways to track down this information-and credentialers are great at coming up with creative ways to obtain the needed information. To obtain references from all three locations, a credentialing professional may ask the applicant for names of individuals the applicant worked with at the practice location. Alternatively, the credentialer could find out the name of the chair of the department in which the applicant worked, and send a reference letter to that person. Remember, just because your medical staff bylaws or credentials policies and procedures may require two or three peer references doesn't mean that your organization is limited to that number. If more references are needed to appropriately assess an applicant's competency, then the number should and can be increased.

I recently observed a credentials committee whose members did two phone references on all new applicants. They felt that they learned essential information via these physician-to-physician telephone calls that they never would have obtained in a written request.

References are a vital source of information about current clinical competency. Ensure that your reference form is designed to capture the information you need to make effective credentialing and privileging decisions. Last, don't forget to include information on your form that The Joint Commission now requires (see MS.4.15 - EP #7)

Until next week,

Vicki L. Searcy, CPMSM
Practice Director, Credentialing & Privileging
The Greeley Company
vsearcy@greeley.com
www.greeley.com