Some of the most common mistakes that lead to credentialing-based claims include: sloppy records and/or poor documentation, inadequate evaluation of ‘red flags,’ and lax oversight of quality and/or inadequate re-credentialing and reappointment systems, explained Dr. Sagin.
He went on to list some of the new areas of risk relating to credentialing, such as credentialing of new technologies, turf battles resulting in multiple standards and growing performance databases and data transparency.
When screening a physician, Dr. Sagin said it’s important to ask about his or her malpractice history as far back as ten years. “Be sure to inquire about claims, suits and settlements,” he added.
“How many of you routinely call all the professional references,” he then asked the audience. “Not many. It’s a growing trend in the country to touch base with each one,” he advised.
An audience member then asked about how to handle a reference who offers a negative comment, but adds, “This is off the record.”
Offered Dr. Sagin: “Document it yourself and place the note into the physician’s file. You won’t make a decision based on that comment, but you will use it as a spring board to conduct further investigation.”
He added that anytime a reference says “off the record,” it should be considered a red flag. “It needs to be reported to the credentialing committee. You can document it and tell the committee about it, then ask the applicant for additional references.”
Dr. Sagin suggested that, when requesting additional references, it would be helpful to ask that specific questions are answered in the letters of reference, such as, “Has applicant ever been reprimanded?”
“It’s the doctor’s right to see the file, so keep that in mind,” he said. “Be sure to have a policy in place in case this situation arises.” He explained that typically, policies allow the applicants to see all factual information in the file, but not opinion-based documentation, such as a reference letter, complaint or peer review.
Other important credentialing information Dr. Sagin listed during his presentation include:
- Lifetime licensure history
- Lifetime medical education and training history
- Specialty board status
- Sanctions
- Lifetime criminal history
- Healthcare-related employment/appointment history
- Past 6 to 12 months of clinical activity
- Review for consistencies between applicant and verified information
- Gaps in practice or malpractice coverage
Dr. Sagin noted that some good practices that will help to avoid negligence claims include excellent credentialing policies, periodic audits of compliance and documentation and adequate training of credentialing staff, physician leaders/committee members and board.