How do you address OPPE and FPPE with low- and no-volume providers?

This week’s quick tip comes from an exchange adapted from HCPro’s webinar, “OPPE and FPPE Case Study: Award-Winning Professional Practice Evaluation Transformation,” now available on demand. Raechel Rowland, RN, BSN, LSSBB, lean practitioner at Ascension Borgess Health in Kalamazoo, Michigan, discusses evaluating low- and no-volume providers.

Q: How do you address OPPE and FPPE with low- and no-volume providers?

Rowland: For low- and no-volume providers, you have the room to say you want to evaluate a certain time frame, but you can also say you want to tie that to a number of procedures. Imagine, for example, that your medical staff has decided that new practitioners in a particular specialty must undergo FPPE for five central line placements within the first 90 days of practice. After this initial period, however, a new affiliate has only placed one central line. You have the room to extend FPPE for that particular practitioner. It doesn't earn you a ding from The Joint Commission.

Alternatively, if you find that practitioners are regularly failing to place five central lines within 90 days, you can remove the timeline component from your FPPE criteria altogether. That way, if it takes a particular provider six months to do five central lines, then so be it.

For no-volume providers, sticking to a set time frame allows the medical staff and quality teams to assess the appropriateness of a certain privilege for the practitioner’s true scope of practice. If the FPPE time frame for a certain privilege is six months, and a provider has not used the privilege once within that period, do you want to renew it? If it's something that the practitioner is absolutely not utilizing, then the privilege might have to be placed on hold or suspended until he or she is using it on a regular basis again. It's not a punitive thing, it's just a way of showing that the practitioner is not using the privilege often, and we don't have a good way to ensure that he or she is doing it well.

Sometimes alerting practitioners to the fact that one or more of their privileges are at risk inspires them to actually come in and do cases because they don't want to lose their privilege. This lets them know that they have to demonstrate their abilities.

In regard to OPPE, you might decide to evaluate certain practitioner outliers more frequently than your typical timeline. It doesn't have to be across the board that all OPPEs must be performed on the same timeline. If, for example, you typically perform OPPE every six months, you might decide to review a particular privilege or provider quarterly because you're not getting enough information—better to do it more frequently than not frequently enough and have a skeleton of information. You at least need to demonstrate that you're trying to substantiate how providers are performing.

If you make those changes and do FPPE every three months, and you still don't have anything to show, you may have to make that hard decision of whether that person really needs to hold that privilege. Your internal culture will dictate who makes that decision and how to carry it out. Is it your medical executive committee? Does it go to your peer review committee? Is it in the hands of the person in charge of the involved discipline/specialty?

Source: News & Analysis