"When bad or imposter physicians slip through the system, patients pay the price!"

To most physicians, the word "credentialing" conjures up visions of needless, tedious paperwork. Professionals in credentialing business view credentialing as the shield of protection for their patients and for the healthy society. This article will define the purpose, process and the outcomes of credentialing.

Hospitals and health care centers all over the globe are aiming for accreditation and they are substantially adopting the best medical credentialing and privileging methods to ensure that the physicians, doctors or even the nurse in-charge of the patient's treatment has adequate education, training and experience, to maximize the safety in health care system.

Credentialing and privileging are the two important processes which allows a hospital to optimize the utility of its most crucial assets- the specialists (doctors, physicians, surgeons, nurses etc) and provide efficient and quality patient care to foster a healthy society. The concept of credentialing the medical practitioners is gaining momentum with the dawn of corporate healthcare and increasing numbers of hospitals choosing different quality standards.

What is credentialing? How does it stop bad / imposter physicians from reaching patients? Credentialing term is used to describe the process of collecting; verifying; and evaluating the education, training, professional experience, work history, and licensure of providers. The process also includes making recommendations regarding category of medical staff membership and clinical privileges based upon the information received.

How the credentialing process works?

Credentialing is a process by which the organization (hospital or medical/health care centers) verifies the authenticity and appropriateness of the qualifications and work experience of a medical practitioner. On foremost basis the need has to be determined. This includes minimum number of years of experience, quantity and nature of work done, preference to particular type of institute from where the person has graduated.

A core committee comprising CEO, medical director and senior medical administrator must be on a credentialing bench. Evidence of licensure, registration, certification, and/or other relevant credentials, for verification prior to appointment and throughout the employment process should be checked. Experts must stress on a reference check through a known contact. The credentialing committee passes on its final recommendation/instructions through which the decision has to be made for hiring and privileging.

A Step by Step Credentialing Process:

  • The doctor who applies for association to a hospital fills a credentialing form, giving details of his formal training and work experience.
  • The head of medical services and the department head try to verify these details with the primary source or University.
  • A formal reference check is done in communication with a senior professional whom the candidate has trained with or worked under.
  • Assess the need for that particular skill in the organization.
  • Meet the candidate.
  • If found suitable, the candidate is recommended for appointment to the medical staff by the credentialing and privileges committee and the management of the organization.
  • There would also be a review of any medico-legal cases in which the candidate is currently involved.

5 Red Flags When Credentialing the Medical Practitioners:

High mobility:A physician who has moved from state to state or from hospital to hospital every couple of years, who is licensed in several states, or who is a member of the medical staffs of several hospitals in several cities may be attempting to cover up some sort of professional problem.

Professional liability suits:While malpractice claims are not necessarily an indication of a problem, the hospital should be wary of physicians who have been involved in a number of professional liability suits.

Professional disciplinary actions: The hospital should be concerned about physicians who have been disciplined, sanctioned, or suspended, or whose privileges have been restricted by a licensing board or another hospital.

Substance abuse:A practitioner impaired by alcohol or drug abuse may apply for medical staff membership and privileges.

Time gaps:If an application reveals an unexplained time gap in training or professional practice, it should be investigated, (anything over 30 days).

Incomplete application:Incomplete sections relate to questions about licensure, hospital disciplinary actions, liability claims history, and health status.

Benefits of a Fool-Proof Credentialing Process

"Credentialing is like reading between the lines verifying everything claimed with everything verified". Credentialing is the process which is saving lives and minimizing the risks of medical negligence and medical malpractice. It provides a higher level of trust and guarantee that the medical practitioner is licensed and Board Certified and has not had licenses or privileges revoked in any other purpose or state. It can be helpful in determining the quality of delivery of health care provided by the medical person.