Regulatory Requirements

Empowering Change: A Medical Services Professional's Guide to Transitioning to 3-Year Appointment Cycles

By Vicki Mash, MBA, CPMSM, CPCS

The mere thought of transitioning from a two-year to a three-year appointment period sounds overwhelming and daunting. However, many healthcare organizations have taken the leap to make this transition and have done it successfully. This heavy lift can take considerable thought, planning, communication, teamwork, collaboration, methodical thinking, medical services leadership buy-in, and — most of all — the right mindset. Prior to initiating a planning process to transition to three-year appointments, be sure to reference your state rules to determine if a three-year appointment is permitted.

Is this something your organization would like to consider? If so, you are probably wondering, “Where do we begin”? This article will provide you with the tools needed not only to begin planning, but to procure a successful outcome. Considering all organizations are structured differently, the following information is based on a typical hospital structure. Please keep in mind that your organization may differ based on assembly and may involve additional steps/approvals.

Seek Approval From Stakeholders

Initially, you should seek approval from key stakeholders including the medical services team, department leaders, and the board. Be sure to involve a member of the legal team (if applicable). Clearly identify the individuals for the project team and be sure to include either a project manager or a member of the operational excellence team to assist with mapping out the new process.

Advantages of a 3-Year Appointment Cycle

There are numerous advantages involved with moving from a two-year to a three-year appointment (See Exhibit 1).

Exhibit 1

First, this presents the opportunity to create additional appointment cycles which would decrease the number of providers appointed in any one cycle. With fewer files per appointment, this also reduces the number of errors that would occur overall, as well as fewer files for medical services leadership to review at one time.

This change will also improve customer satisfaction considering the appointment would now be spread over three years versus two, resulting in less paperwork to complete per provider. If you work in an organization with multiple hospitals and they all fall under different appointment cycles, this would be an exceptionally suitable time to systemize that process.

To ensure success, methodical thinking in this transition is key. A crucial step is identifying what the process should look like for the appointment cadence to prevent fallouts. Something to keep in mind is that during the mapping process, some appointments will be moved into a different cycle, causing a back-to-back appointment. Strategic planning and communication with your medical services team can prevent this from frequently occurring and causing frustration.

Furthermore, if your organization is utilizing a credentialing software product, it will be necessary to speak with your vendor to advise them of the project. They may very well have insights or important barriers to overcome for a successful project.

Next, to align the process with your documentation, the governing documents associated with appointment periods will need to be modified and updated. This may include but is not limited to your medical staff bylaws, rules and regulations, and policies and procedures. Additionally, there may be a need to modify the language on your privilege forms pertaining to volume requirements for specific specialized privileges or overall volume for appointment.

Plan and Strategize

Other elements to strategize and coordinate include ensuring that quality reviews are consistent. It is essential to pay close attention to the OPPE annual process to meet CMS requirements of reviewing surgical privileges. For example, CMS says surgical privileges should be reviewed and updated at least every two years.

Remember, it takes a village. A well-planned strategy, working together in tandem, and staying in close communication is key to the success of the project.

If you have any questions regarding this article please contact via email: Nyleen Flores, Bert Gay, Debbie Kesselring, Vicki Mash, or Dana Wakefield.