Competency assessment in the 21st century

With the rise of healthcare services outside traditional hospital settings, outpatient practitioner credentialing and peer review are challenging medical staff services departments nationwide. We spoke with 2016 Credentialing Resource Center Symposium presenter Todd Sagin, MD, JD, president of Sagin Healthcare Consulting Services LLC, about some of the challenges.

Q: What are some of the unique challenges of credentialing and peer review in the outpatient setting?

A: Credentialing in an outpatient setting is relatively new for hospitals, but managed care payers have been doing it for quite some time.

The real challenge on the outpatient side comes when we try to apply the principles of inpatient privileging to the ambulatory world. First of all, many organizations have only a vague idea of what clinical activity is going on in physician office practices. For example, which practices utilize laser procedures for cosmetic or other purposes? In which offices are joint injections performed? Who is doing pocket ultrasounds? And so forth.

Then there is the question of what activities should have their own competency criteria, who should determine these criteria, and who should assure they are being met.

Regarding peer review, there is very little meaningful ambulatory/office-based competency evaluation going on across the nation. This is a troubling reality because most clinical care is delivered outside the peer review processes of hospitals. To date, there is very little infrastructure in existence to help carry out such work. Quality departments are hospital-based and most clinical databases that support peer review are based on hospital information systems.

Once again, the insurance industry holds most of the clinical data available in the ambulatory world, although this will start to change with the widespread implementation of electronic health records. Furthermore, medical staff peer review bodies have historically done very little oversight of work being done in the ambulatory arena. The fact that ambulatory medicine is largely delivered in geographically dispersed small office settings is another barrier to the effective deployment of historically utilized peer review techniques.

Editor’s note: This topic will be highlighted during the 2016 Credentialing Resource Center Symposium, during the session Practitioner Credentialing and Competency Assessment in the 21st Century. To learn more about the Symposium, April 7-8, in Orlando, click here.