Synergy - September/October 2013 - 10
industry feature
The Intersection of Credentialing and Peer
Review: How Much Information Is Enough?
By Ramona H. Thomas, Esquire
Quiz on page 14; Worksheet on page 30
M
ost jurisdictions impose a legal
duty on healthcare facilities to
use due care in selecting the
physicians appointed to the medical
staff.1 A failure to exercise such due care in
the credentialing process can result in the
facility’s liability for patient injuries arising
from the exercise of privileges by
unqualified, unskilled, or incompetent
physicians.2 The Joint Commission’s
standards outline criteria that must be
considered as a part of the credentialing
process, including, among other factors,
voluntary and involuntary termination of
medical staff membership, and voluntary or
involuntary limitation, reduction, or loss of
clinical privileges.3 To evaluate these factors,
a facility must make inquiries regarding a
physician’s affiliations with other facilities.
10
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SYNERGY September/OctO ber 2013
Occasionally, information a facility receives in
response to an affiliation verification request
may include information about peer review
proceedings or adverse actions. A National
Practitioner Data Bank (NPDB) query will
reveal whether another facility has reported
an adverse action taken against a physician
applicant. In either situation, the credentialing
facility has two important questions to
answer: (1) what information should we
request and review about the other facility’s
actions regarding this physician; and (2)
should the other facility’s action have any
impact on our credentialing decision?
This article identifies judicial decisions
addressing both questions and discusses
the facility’s options for proceeding when it
learns that a physician applicant has been
the subject of peer review proceedings or an
adverse action at another facility.
What Should Be Requested
and Reviewed
In Johnson v. Misericordia Comm. Hosp., the
Wisconsin Supreme Court found hospitals
have an obligation to investigate and confirm
the credentials of practitioners appointed to
their respective medical staffs. The court held
that a hospital had not exercised ordinary
care when it failed to “make a reasonable
effort to determine whether the physician
was qualified to perform” the privileges
he requested.4 In that case, a patient sued
a hospital after an unsuccessful surgical
procedure, alleging the hospital negligently
selected the physician who performed the
Synergy - September/October 2013
Table of Contents for the Digital Edition of Synergy - September/October 2013
Synergy - September/October 2013
Contents
Editor’s Column
President’s Column
The Intersection of Credentialing and Peer Review: How Much Information Is Enough?
The Medical Staff’s Role in a Provider-Based Facility
Paperless Agenda Versus Less Paper
CMS Grants the Center for Improvement in Healthcare Quality (CIHQ) Deeming Authority
National Organization Seeks to Imp rove Process with NAMSS PASS™
MS 01.01.01 – One Year Later: Did You Make It? Did You Survive?
NAMSS News
Happenings
Consultants Directory
Synergy - September/October 2013 - Synergy - September/October 2013
Synergy - September/October 2013 - Cover2
Synergy - September/October 2013 - 1
Synergy - September/October 2013 - Contents
Synergy - September/October 2013 - 3
Synergy - September/October 2013 - 4
Synergy - September/October 2013 - 5
Synergy - September/October 2013 - Editor’s Column
Synergy - September/October 2013 - 7
Synergy - September/October 2013 - President’s Column
Synergy - September/October 2013 - 9
Synergy - September/October 2013 - The Intersection of Credentialing and Peer Review: How Much Information Is Enough?
Synergy - September/October 2013 - 11
Synergy - September/October 2013 - 12
Synergy - September/October 2013 - 13
Synergy - September/October 2013 - 14
Synergy - September/October 2013 - 15
Synergy - September/October 2013 - The Medical Staff’s Role in a Provider-Based Facility
Synergy - September/October 2013 - 17
Synergy - September/October 2013 - Paperless Agenda Versus Less Paper
Synergy - September/October 2013 - 19
Synergy - September/October 2013 - CMS Grants the Center for Improvement in Healthcare Quality (CIHQ) Deeming Authority
Synergy - September/October 2013 - 21
Synergy - September/October 2013 - National Organization Seeks to Imp rove Process with NAMSS PASS™
Synergy - September/October 2013 - 23
Synergy - September/October 2013 - 24
Synergy - September/October 2013 - 25
Synergy - September/October 2013 - MS 01.01.01 – One Year Later: Did You Make It? Did You Survive?
Synergy - September/October 2013 - 27
Synergy - September/October 2013 - NAMSS News
Synergy - September/October 2013 - 29
Synergy - September/October 2013 - 30
Synergy - September/October 2013 - Happenings
Synergy - September/October 2013 - Consultants Directory
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