Credentialing and privileging monthly: Alien invasion or attack of the skeptics?

I recently met with some medical staff leaders at a hospital in the Midwest to discuss implementation of focused professional practice evaluation (FPPE) for practitioners new to the medical staff. The chief of staff turned to me and said, “I can’t think of anything more alien that we have been asked to do by the regulators than FPPE.” It was not the first time that I have heard this sentiment.

Naturally, being a child of the 50s and 60s, the word alien conjures up images of black and white science fiction movies, Vulcans and Klingons, and Star Wars. Aliens always cause us to think about the strange and the unknown, but perhaps it is better to think of FPPE as made up of things we are already familiar with, just packaged differently.

FPPE asks that medical staffs have a process to examine a practitioner’s competency in a focused and timely manner when it has no first-hand information about that practitioner’s competency to perform given privileges. Practitioners who are new to the medical staff represent the largest group that requires FPPE.

FPPE should evaluate a practitioner’s competency for the privileges that the medical staff has granted him or her in a timely manner so as to provide the medical staff with adequate first-hand knowledge. The medical staff conducts FPPE on this practitioner until it feels comfortable ending the focused review and initiating ongoing professional practice evaluation (OPPE).

Many medical staff leaders assume that FPPE is equivalent to proctoring or real-time observation. However, there is no prescribed method for conducting FPPE. Proctoring is one tool that is most useful for procedure-based privileges such as endoscopies, cardiovascular interventional procedures, and surgeries. It isn’t terribly useful for cognitive-based medical activity such as that of the family practitioner or general internist. For cognitive-based medical activity, one could consider doing prospective evaluations, which requires the physician to present to the medical staff an evaluation of the patient and the proposed diagnostic and therapeutic plan. However, this method has limited usefulness. The medical staff could gather more information using retrospective case review to examine the medical applications and the subsequent patient course.

Many leaders have seen FPPE as something entirely new, and therefore an extra burden. But if you think about it, haven’t we already done this type of upfront evaluation of new medical staff members in an informal way? When a new doctor gets started in practice, it is common for the chief of the department or other medical staff leader to ask how the new guy is doing. I can recall many of those conversations occurring at the lunch table in the doctor’s dining room or in the hallways of the hospital. Leadership saw a responsibility to make sure that the new physician on staff was doing well and not running into problems. If the medical staff received reports of less-than-adequate performance, it instituted more formal oversight. So, in a way, most medical staffs had an FPPE process—albeit not codified or documented.

FPPE is a way of systematizing and standardizing an observational and informational process concerning new practitioners that was there all along. Perhaps the major difference will be that if anyone asked us to prove that we were watching and measuring performance, we will now have the documentation to demonstrate that we did.

If we can acknowledge that FPPE connects to how we informally used to evaluate newbies, maybe some of the negative emotions regarding FPPE can be channeled into figuring out more efficient and effective ways to create the process. Maybe, the alien reference can be retired.

If you need help creating an effective FPPE policy or establishing the process, please feel free to contact us to discuss those situations.

Mark Smith, MD, MBA, FACS, CMSL, is the director of credentialing and privileging services at The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.