Taking the next step in AHP credentialing

Dear Colleague,

Credentialing allied health providers (AHP) is one of the most common challenges we at The Greeley Company are asked to help solve. With the looming physician shortage and a growing number of nurse practitioners, physician assistants, CRNAs, and other AHPs practicing in hospitals, we can expect more challenges ahead. The problem is that most hospitals are only doing a perfunctory job of credentialing AHPs. Some have adopted some version of privilege delineation, put in place a policy about physician supervision of AHPs, and thrown together a rudimentary report that passes for ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) (usually with quite a bit of difficulty). But that’s where it usually stops.

The problem with this approach is that these activities ultimately tell us precious little about the competence of AHPs to fulfill the privileges they’ve been granted. (We’ll set aside the fact that most hospitals still struggle to develop meaningful credentialing information about physician competence.) The two biggest barriers to obtaining more meaningful credentialing information about AHP competence are supervision and attribution. Let’s tackle these one at a time.

It’s a rare hospital that does a good job ensuring adequate physician supervision of AHPs. Most AHP supervision is perfunctory, when it happens at all (beyond simply having physicians cosign their records). This is a solvable problem, but it means designing and implementing a clear policy covering AHP supervision. Every policy should begin with defining what supervision means. Beyond that, medical staffs should ask themselves the following questions: Must supervision always be onsite or can some supervision be carried out offsite?
 

• How will “onsite” be defined?
• If an AHP is working under a protocol, does this change the supervision required?
• Who approves AHP protocols?
• What will an AHP taking first call to cover the emergency department be authorized to do?
• How will supervision requirements be enforced?

The next challenge, attribution, is going to be even tougher to solve. Attribution is the process of connecting information gained from peer review measurement activities to a particular provider. The problem here is that most hospital data systems are built to link performance information to an attending physician or operating surgeon, not an AHP.

The medical staff may be able to measure AHP performance through individual medical record review, but even then, knowing which cases should be pulled to measure a particular AHP’s performance is a challenge. This leaves the medical staff dependent on incident reports, which are only generated when bad things happen. Medical staffs may ask clinicians who work with an AHP on a regular basis to periodically complete a form assessing the AHP’s clinical performance. Each of these methodologies can help medical staffs obtain more useful AHP performance information. But if medical staffs hope to achieve the most meaningful data on AHP competence, they should ask their hospital’s data system plan for and achieve accurate attribution of quality measures to individual AHPs. This is what it will take to really credential AHPs.

All the best,

Rick Sheff

Richard A. Sheff, MD, CMSL, is chair and executive director of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.