Stave off negligent credentialing suits

Identifying red flags within credentialing applications can be the first step to protecting yourself and your facility from a successful plaintiff litigation. In Negligent Credentialing: Best Practices to Prevent Successful Plaintiff Litigation, expert Mark A. Smith, MD, MBA, FACS, shares best practices for preventing credentialing-based lawsuits, as illustrated by the following exchange from the Q&A portion of the program.

Q: How can we convince the credentials committee to deny privileges to a provider who doesn’t have established clinical competence?

A: There are two potential situations here. One involves an initial applicant. Don’t process the application if they don’t meet the criteria for competence. If you don’t process the application, then there’s no denial, no fair hearing, and it’s a much easier process.

Enlist the credentials committee’s help in individually identifying situations where there might be red flags, and commit to getting all necessary information before deeming the application complete and starting the process. That’s the easier situation.

The harder situation is the person with privileges who’s up for reappointment. Remember, we don’t extend privileges at reappointment; we create new privileges. The physician’s privileges expire at the end of the appointment period, and at reappointment, essentially we re-grant the privileges that the physician had. That’s an opportunity to say whether we have the right criteria for current competency, and we get to evaluate our practitioners against our criteria. It makes the case for criteria-based privileging and having clear criteria that identify what current competence looks like.

This leads into the argument about whether we should have numbers for privileges. There are some areas, such as cardiac surgery, where it’s reasonable to say, “To be currently competent, you must have done a certain amount of work.” But for the most part, this can be a local decision. You want your criteria to be reasonable—not ridiculous. Saying someone is competent because they saw one patient in two years probably is not defensible. But if someone is seeing 30 patients in two years, you can make the argument that it’s reasonable to grant privileges. Think about your criteria because that’s going to help support how you determine current competency.

You must also have a good OPPE process with strong data to look at the quality side of competency. That’s the “Have you done it well?” part of the competency equation. If you have data that says everything’s great except in this one area, you can make a reasonable current competency decision.

The illogical leap that we used to make was, “Lack of bad news is good news.” The absence of bad information means they must be good. In reality, the absence of bad information means we have no information. We have to get information one way or the other, and that’s what the push is behind the OPPE process.

For more expert strategy on avoiding negligent credentialing (and dealing with any claims that do arise), purchase the on-demand webcast today!