From the June 2011 issue of HealthCare Business News magazine
Strict controls on the definition of reliable sources of information and the use of those sources have been mandated by federal and state governments, as well as The Joint Commission, National Committee for Quality Assurance, Utilization Review Accreditation Commission and other accreditation bodies.
One area of credentialing improvement recently addressed is the frequency of information updating. This recognition of the need for more frequent credentialing activities was heralded by the 2007 TJC standards. In a radical departure from credentialing principles based on a policy of “What you don’t know can’t hurt you,” TJC deemed credentialing to be a significant organizational duty in the provision of quality patient care. According to these new standards, the goal of credentialing was to identify provider issues by collecting data on an ongoing basis.
Though it’s been four years since this came out, many facilities still have not been able to comply with these standards due to inadequate resources, technology and expertise. The basic framework of credentialing is still only the initial and reappointment cycle. Yet in the not-too-distant future, such periodic credentialing may become as antiquated as the horse and buggy.
Technology is enabling a convergence of point-of-service need with real-time access to provider information. If the trend continues, the requirement to credential at any specific date will be unnecessary as complete credentialing will be continuously performed. For this to happen, insurance data, affiliations, peer references and other manually available information must be converted into electronic databases for constant, automated and secure access. These databases will need to be continuously updated and new requirements may have to be put into place for the sources of such information.
Though these changes are still to come, today there is still an abundance of provider information that can be electronically accessed and monitored in real time, thereby providing immediate and tangible improvement in risk management and efficiency.
Legal consequences
Prior to 1965, hospitals were considered charitable organizations and immune from being sued for negligence. Much has changed since that time and hospitals are now a natural litigation target as they have deeper pockets than individual providers and can be easily exposed to direct liability. Plaintiffs’ attorneys are even now drawing a causal link between provider errors occurring in as many as one-third of hospital admissions, as reported in the journal Health Affairs, and negligent credentialing, thereby laying the legal responsibility at the feet of the organization.
