wht_028___maximize_risk_management_with_good_efficient_credentialing_policies

WHITEPAPER

— Minimizing Credentialing Risk: How to Protect Your Patients and Your Hospital

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WHT-028 - Maximize Risk Management with Good Efficient Credentialing Policies

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— Sometimes serial killers wear white lab coats and carry stethoscopes. Take Dr. Joseph Michael Swango. His current address is the United States Penitentiary, Administrative Maximum Facility, in Florence, CO, otherwise known as the “Alcatraz of the Rockies.” He’s serving three consecutive life sentences for murdering four patients, although the Federal Bureau of Investigation suspects he is responsible for the poisoning deaths of 60 patients and colleagues in the U.S. and Africa over a period of almost 20 years.

This case is disturbing, but what’s more upsetting is that Swango could have been stopped much earlier in his career. Even though Swango was investigated and disciplined at several hospitals where he was on staff, and despite actual convictions and arrests for harming patients, he outmaneuvered the system time and again to find more work as a physician.

Are you doing a good job of mitigating risk to patients and your institution with thorough, efficient credentialing? This whitepaper will explore:

— The consequences of negligent credentialing – including threats to patient well-being as well as legal risks for your institution

— Your credentialing responsibilities

— Ways to minimize risk

What is negligent credentialing?

“Failure to act as an ordinary prudent person or conduct contrary to that of a reasonable person under specific circumstances.”

— National Association of Medical Staff Services



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— What’s at Stake from Negligent Credentialing?Swango represents an extreme case. But there are plenty of examples of bad doctors doing harm to patients and the hospitals that hire them due to faulty, negligent credentialing processes. If you fail to fully vet an applicant who’s applied to work in your hospital, you could be granting privileges to a doctor who may seriously injure or cause the death of your patients. Your applicant may be hiding the following:

— Past or pending investigative proceedings by state licensing boards, medical staff organizations or professional societies;

— Disciplinary actions by medical staff organizations, hospitals, state medical boards, or professional societies;

— Evidence of fraud, abuse or misconduct from professional review organizations, third-party payers, or government entities.

— Jury verdicts (for both criminal and civil court cases);

— Settlements for professional liability claims.

“This is important information that indicates a doctor has a history or pattern of incompetence, negligence or outright abuse in taking care of patients,” said Ray Bixler, Chief Executive Officer of SkillSurvey, Inc., which offers a unique cloud-based solution that helps hospitals and healthcare organizations minimize risk by expediting the professional credential verification process. “Indeed, if any of this information is uncovered from your sources, your medical staff should take great care in verifying and investigating the information.”

Deaths and injuries could have been prevented if Dr. Swango was properly credentialed. At the very beginning of his career, he landed a surgical internship at Ohio State University Medical Center in 1983 – despite a “very poor evaluation1” in his dean’s letter from Southern Illinois University School of Medicine. And, in 1992, only a few years out of jail for poisoning medical staff co-workers, Swango forged legal documents to reestablish himself as a physician and began working at Sanford USD (University of South Dakota) Medical Center in Sioux Falls. One such document was a fact sheet from the Illinois Department of Corrections that falsified his criminal record. He changed it to state he’d been convicted of a misdemeanor for getting into a fistfight with a co-worker and received six months in prison, rather than the five years for felony poisoning that he served.

RECOMMENDED READING Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder by James B. Stewart.

“A medical thriller from Pulitzer Prize–winning author James B. Stewart about serial killer doctor Michael Swango and the medical community that chose to turn a blind eye on his criminal activities.” — Amazon

http://www.amazon.com/Blind-Eye-Terrifying-Doctor-Murder/dp/0684865637





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— Negligent Credentialing Raises Legal RiskNegligent credentialing can raise the risk that your hospital will be sued by patients harmed by the physicians who are hired. Currently, more than half of all U.S. states now recognize negligent credentialing as a reason for litigation against healthcare organizations2.

In late 2015, South Dakota became the latest state where health providers can be sued for failing to properly credential doctors. A circuit court judge that ruled hospitals, as well as members of peer review committees (who keep their findings private), can be held liable. The ruling stems from a case in which three dozen plaintiffs are suing a Yankton, S.D., spine surgeon, as well as two medical facilities and doctors on the credentialing committees. The plaintiffs claim the hospitals credentialed the doctor, knowing he lost credentials at a Nebraska hospital and had previous problems.

In a 2012 Massachusetts case, Rabelo v. Nasif et al., Julio Rabelo, sued defendants Dr. Ronald Nasif, Milford Regional Medical Center, Inc., and Parkway Orthopedics and Sports Medicine, Inc., for medical malpractice. Specifically, Rabelo claimed that Milford Regional negligently credentialed Nasif.

What makes this case significant is that Massachusetts Superior Court recognized that “a cause of action based on negligent credentialing could be brought against Massachusetts hospitals,” according to Health Law Reporter. In the case, the court denied Milford Regional’s motion to separate the defendant’s negligent credentialing claim from the medical malpractice suit against Nasif. The court reasoned that information relating to the hospital’s negligent credentialing of Dr. Nasif “might be valuable” to Rabelo’s malpractice action against him.

Natalie A. Heineman, Esq., in the January 2014 Bulletin of the Physicians Insurance Agency of Massachusetts, noted that the case is “likely to result in more direct claims against hospitals.” She added that “heightened attempts for discovery of credentialing information together with the commensurate motion practice should be expected.”

A 2009 case, in Kentucky, established the right of plaintiffs in that state to cite negligent credentialing in malpractice suits. In The Estate of Judith Burton v. the Trover Clinic Foundation et al., the Burton estate claimed Dr. Philip Trover, chair of the Trover Foundation radiology department, misread Burton’s radiological films – part of a “dangerous habit of reading radiological films at a rate … far in excess of the average workload for a typical private practice3.” Burton died on October 4, 2008, from cancer.

Risk Managers Play a Key Role Risk managers in many hospitals have valuable expertise to share with medical staff professionals and leaders. As a risk professional, here’s what you can do to help protect your hospital from negligent credentialing:

✓ Advocate for education and training for medical staff professionals and medical staff leaders;✓ Encourage networking with other medical staff professionals;✓ Champion certifications for medical staff professionals;✓ Keep the lines of communication open with medical staff professionals;✓ Review credentialing policies and processes;✓ Review reference, affiliation, and training verification forms; ✓ Review and collaborate on wording of sensitive topics and discussions in meeting minutes;✓ Review and collaborate on sensitive affiliation verification responses.



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Initially, Dr. Trover was successful in separating the Burton case into two phases, the first for medical negligence issues, and the second for negligent credentialing. As a result, the trial court returned a verdict against the Burton estate in the first phase.

But an appeals court reversed it, citing an earlier case where it was held that the “Commonwealth recognizes that an employer can be held liable when its failure to exercise ordinary care in hiring or retaining an employee creates a foreseeable risk of harm to a third person.” The appeals court then laid out what a plaintiff must prove to establish a negligent credentialing case in Kentucky:

— The defendant hospital owed the patient a duty to ensure a competent medical staff;

— The hospital breached that duty by granting privileges to an incompetent or unqualified physician;

— The physician caused harm to the patient.

Noted John C. Whitfield, co-founder of Whitfield Bryson & Mason LLP, in the February 2012 edition of the Kentucky Justice Association’s Advocate Magazine: “The opinion certainly was a breath of fresh air for those litigators within the Commonwealth whose clients have been the victim of institutional negligence in the credentialing process.”

— Good Credentialing – Your First DefensePrevent harm to your patients and damage to your hospital by practicing thorough and efficient credentialing. NAMSS offers a guideline in its Ideal Credential Standards — evidence-based evaluation that verifies 13 specific criteria from primary sources.

NAMSS recommends that hospitals collect the following pieces of information to fully vet an applicant:

1. Proof of identity

2. Education and training

3. Military service

4. Professional licensure

5. DEA Registration and State DPS and CDS Certifications

6. Board certification

7. Affiliation and work history

8. Criminal background disclosure

9. Sanctions disclosure

10. Health status

11. National Practitioner Data Bank (provides healthcare-specific information on state and federal criminal convictions and civil judgments, as well as malpractice history and hospital sanctions)

12. Malpractice insurance

13. Professional references

According to NAMSS, your medical facility should incorporate the 13 criteria into your staff bylaws, rules and regulations, and other governance documents to ensure that your credentialing process is “objective, systematic, and without discrimination or bias.”

http://www.namss.org/Portals/0/Regulatory/NAMSS%20Roundtable%20Credentialing%20Best%20Practice%20Criteria%20White%20Paper.pdf



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— Improving Your Credentialing Infrastructure Centralizing the credentialing process also minimizes risk. For example, you boost control and reduce the risk of critical information falling through the cracks (and missing proper scrutiny) when you adopt the use of standardized processes and forms.

In addition, your organization can benefit tremendously by automating credentialing – transforming a traditionally paper-heavy process that depends on medical staff services to investigate areas of concern as well as email and fax replies. Today’s most sophisticated credential technology automatically notifies credentialing specialists of potential red flags based on specified criteria and allows peer references to quickly and easily respond online anytime from anywhere, using their mobile device, tablet or computer.

“Because traditional wait times for information sent by medical staff and peer references run between four and five weeks, it may be tempting to forgo some information and prematurely complete a credentialing process,” said Bixler. “But medical facilities don’t have to take that risk anymore—today’s best credentialing software can flag issues and automatically send reminders to third parties which are typically delivered back in as short as four to five days. With important information in hand when you need it, you can make intelligent, safe decisions.”

A good centralized, automated credentialing system should offer:

— Streamlined referencing and privileging processes – fully automated and paperless, allowing a peer reference to respond immediately online without the need to print an emailed attachment, sign it manually, and scan, fax, or mail it back to you;

— Cloud-based operations – the ability for peer references to complete their reference responses through their web browser of choice or from their iPhone, iPad or other mobile device;

— Automatic red flag alerts – automated indicators for areas of concern that require further investigation, customized according to your organization’s criteria

— Integration with your existing system – takes your existing forms and delineation of privileges and creates online, automated versions with your corporate logo;

— Fast response times – because the technology allows users to respond electronically;

— Quick implementation and training – implementation should take only a few weeks, and should incorporate the expertise of medical staff alumni who thoroughly understand your needs. Training should be minimal, based on intuitive use of the software.

Some Primary Sources of Info4: Professional licensure: State licensing boards, Federation of State Medical Boards (FSMB)

Board certification: American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

Criminal background disclosure: National, state and county criminal databases

Sanctions disclosure: National Practitioner Data Bank, Office of Inspector General, The General Services Administration’s Excluded Parties List System (EPLS), System for Award Management, FSMB.



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— About SkillSurveySkillSurvey is the leader in online reference checking and credentialing, providing immediately useful insights to help employers make better hiring decisions. SkillSurvey speeds hiring for healthcare organizations. SkillSurvey Credential OnDemand™ provides healthcare organizations with streamlined digital credentialing that simplifies and enhances the credentialing experience for all participants. SkillSurvey makes the referencing and credentialing process more efficient and effective — helping employers save time and money, grow revenues, and bring employees onboard faster.

SkillSurvey’s cloud-based software products are being used by 1,400 companies, institutions and organizations, including more than 800 healthcare organizations. Visit SkillSurvey at www.skillsurvey.com, and on Facebook, LinkedIn, and Twitter.

— References1. http://murderpedia.org/male.S/s/swango-michael.htm

2. http://www.piam.com/news/malpractice/jan2014/credentialing.php

3. Negligent Credentialing in Kentucky, February, 2012, Whitfield Bryson & Mason LLP

4. The Ideal Credentialing Standards: Best Practice Criteria and Protocol for Hospitals, NAMSS, 2014

You are the first line of defense against negligent and abusive doctors. Take care to adhere to proven, standardized credentialing best practices. And consider converting from disjointed, manual processes to centralized, automated credentialing. You’ll help protect your patients and your medical facility.

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http://www.piam.com/news/malpractice/jan2014/credentialing.php

http://www.namss.org/Portals/0/Regulatory/NAMSS%20Roundtable%20Credentialing%20Best%20Practice%20Criteria%20White%20Paper.pdf

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